Provider Demographics
NPI:1811055163
Name:BALLARD, MARIA CASTORIO (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:CASTORIO
Last Name:BALLARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 JOHNSTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012
Mailing Address - Country:US
Mailing Address - Phone:704-829-5416
Mailing Address - Fax:
Practice Address - Street 1:901 SOUTH NEW HOPE ROAD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054
Practice Address - Country:US
Practice Address - Phone:704-884-2501
Practice Address - Fax:704-884-2565
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0045201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical