Provider Demographics
NPI:1295494235
Name:BALLINGER, NICOLE (PSYD, LSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BALLINGER
Suffix:
Gender:F
Credentials:PSYD, LSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:BALLINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RUSSELL
Mailing Address - Street 1:814 SUNSEEKER DR
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-6143
Mailing Address - Country:US
Mailing Address - Phone:479-401-0844
Mailing Address - Fax:
Practice Address - Street 1:814 SUNSEEKER DR
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-6143
Practice Address - Country:US
Practice Address - Phone:479-401-0844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-16
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPLSW5511103TC0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical