Basic Information
| Provider Information | |||||||||
| NPI: | 1457479487 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALLARD | ||||||||
| FirstName: | PEARLINE | ||||||||
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| Credential: | SOCIAL WORKER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15711 MARK TWAIN | ||||||||
| Address2: | 3646 MT ELLIOTT | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132733656 | ||||||||
| FaxNumber: | 3139211182 | ||||||||
| Practice Location | |||||||||
| Address1: | 3646 MT ELLIOTT | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139214700 | ||||||||
| FaxNumber: | 3139212882 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6802085655 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.