Healthcare Provider Details

I. General information

NPI: 1619081973
Provider Name (Legal Business Name): JAMES MOSES BALLARD II PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 PENNSYLVANIA AVE SE SUITE 440
WASHINGTON DC
20003-4318
US

IV. Provider business mailing address

650 PENNSYLVANIA AVE SE SUITE 440
WASHINGTON DC
20003-4318
US

V. Phone/Fax

Practice location:
  • Phone: 202-544-5440
  • Fax: 202-544-3004
Mailing address:
  • Phone: 202-544-5440
  • Fax: 202-544-3004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY354
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: