Healthcare Provider Details

I. General information

NPI: 1588984769
Provider Name (Legal Business Name): RAFFAELA BALLARD CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MECHANIC ST
LAUREL DE
19956-1004
US

IV. Provider business mailing address

1241 COLLEGE PARK DR
DOVER DE
19904-8713
US

V. Phone/Fax

Practice location:
  • Phone: 302-877-0444
  • Fax:
Mailing address:
  • Phone: 302-735-7790
  • Fax: 302-735-3654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number600
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: