Provider Demographics
NPI:1780746834
Name:BALLARD, NANCY ANNE (LCSW, MHP)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ANNE
Last Name:BALLARD
Suffix:
Gender:F
Credentials:LCSW, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:GA
Mailing Address - Zip Code:31064-1256
Mailing Address - Country:US
Mailing Address - Phone:706-468-0473
Mailing Address - Fax:706-468-0473
Practice Address - Street 1:951 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:GA
Practice Address - Zip Code:31064-2108
Practice Address - Country:US
Practice Address - Phone:706-202-0013
Practice Address - Fax:706-468-0473
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0022801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical