Provider Demographics
NPI:1982617346
Name:BALLARD, LAURA ELIZABETH (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ELIZABETH
Last Name:BALLARD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 WESTBARD CIR APT 305
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-1468
Mailing Address - Country:US
Mailing Address - Phone:703-578-0030
Mailing Address - Fax:
Practice Address - Street 1:5525 TWIN KNOLLS RD
Practice Address - Street 2:SUITE 327
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3266
Practice Address - Country:US
Practice Address - Phone:703-578-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040061551041C0700X
MD128701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical