Provider Demographics
NPI:1457591521
Name:BALL, TERESA LYNNE (LISW-CS)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:LYNNE
Last Name:BALL
Suffix:
Gender:F
Credentials:LISW-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2863 STATE ROUTE 45 N
Mailing Address - Street 2:GLENBEIGH
Mailing Address - City:ROCK CREEK
Mailing Address - State:OH
Mailing Address - Zip Code:44084-9352
Mailing Address - Country:US
Mailing Address - Phone:440-710-3222
Mailing Address - Fax:440-563-3206
Practice Address - Street 1:2863 STATE ROUTE 45 N
Practice Address - Street 2:
Practice Address - City:ROCK CREEK
Practice Address - State:OH
Practice Address - Zip Code:44084-9352
Practice Address - Country:US
Practice Address - Phone:440-710-3222
Practice Address - Fax:440-563-3206
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH902783101YA0400X
PACW0138811041C0700X
OHI 00087261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)