Basic Information
Provider Information | |||||||||
NPI: | 1932129517 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BALLENGER | ||||||||
FirstName: | CHRISTINE | ||||||||
MiddleName: | ASHLEY | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PSY.D., LPC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | KISTLER | ||||||||
OtherFirstName: | CHRISTINE | ||||||||
OtherMiddleName: | ASHLEY | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PSY.D., LPC | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1048 TERRACE DR | ||||||||
Address2: |   | ||||||||
City: | MARION | ||||||||
State: | VA | ||||||||
PostalCode: | 243544138 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2767831827 | ||||||||
FaxNumber: | 2767832879 | ||||||||
Practice Location | |||||||||
Address1: | 139 W MAIN ST | ||||||||
Address2: |   | ||||||||
City: | MARION | ||||||||
State: | VA | ||||||||
PostalCode: | 243542531 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2762439999 | ||||||||
FaxNumber: | 8555294516 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/19/2006 | ||||||||
LastUpdateDate: | 03/17/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 0810005807 | VA | Y |   | Behavioral Health & Social Service Providers | Psychologist |   |
No ID Information.