MEDICARE: CAROLYN M. BALL LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	4735	SC
2	101YP2500X	Professional Counselor	801	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861403842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN M. BALL LPC

Provider Business Mailing Address
First Line	:	890 BRIARWOOD DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-5740
Country	:	US
Telephone Number	:	843-272-4114
Fax Number	:	843-272-4114

Provider Business Practice Location Address
First Line	:	890 BRIARWOOD DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-5740
Country	:	US
Telephone Number	:	843-272-4114
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/09/2007

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Directions to “ CAROLYN M. BALL LPC” Practice Location

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