Provider Demographics
NPI:1861291163
Name:BALLARD, NACOLE (LAPC, NCC, CTP)
Entity type:Individual
Prefix:
First Name:NACOLE
Middle Name:
Last Name:BALLARD
Suffix:
Gender:F
Credentials:LAPC, NCC, CTP
Other - Prefix:
Other - First Name:FRANCISE
Other - Middle Name:
Other - Last Name:BALLARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:138 CANAL ST STE 303
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4046
Mailing Address - Country:US
Mailing Address - Phone:912-433-7829
Mailing Address - Fax:
Practice Address - Street 1:10393 FORD AVE BLDG C2ND
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-8811
Practice Address - Country:US
Practice Address - Phone:770-733-0635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC010238101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor