Basic Information
| Provider Information | |||||||||
| NPI: | 1619081973 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALLARD | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | MOSES | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | PHD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 650 PENNSYLVANIA AVE SE | ||||||||
| Address2: | SUITE 440 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200034318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2025445440 | ||||||||
| FaxNumber: | 2025443004 | ||||||||
| Practice Location | |||||||||
| Address1: | 650 PENNSYLVANIA AVE SE | ||||||||
| Address2: | SUITE 440 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200034318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2025445440 | ||||||||
| FaxNumber: | 2025443004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY354 | DC | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | PSY354 | 01 | DC | STATE LICENSE | OTHER |