Provider Demographics
NPI:1295998896
Name:BALLARD, JAMES M III (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:BALLARD
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4200 FORBES BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706
Mailing Address - Country:US
Mailing Address - Phone:410-361-0658
Mailing Address - Fax:410-647-7931
Practice Address - Street 1:4200 FORBES BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4342
Practice Address - Country:US
Practice Address - Phone:410-361-0658
Practice Address - Fax:410-647-7931
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD04420103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical