Provider Demographics
NPI:1780297101
Name:BALLINGER, MISHALE ANN REDE (APCC, LPCC)
Entity type:Individual
Prefix:
First Name:MISHALE
Middle Name:ANN REDE
Last Name:BALLINGER
Suffix:
Gender:F
Credentials:APCC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4690 GRAVENSTEIN HWY N
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-2242
Mailing Address - Country:US
Mailing Address - Phone:805-610-3200
Mailing Address - Fax:
Practice Address - Street 1:405 JACKSON DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-4209
Practice Address - Country:US
Practice Address - Phone:805-610-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional