Healthcare Provider Details

I. General information

NPI: 1144966805
Provider Name (Legal Business Name): CARLY MARIE BALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 PRIVATE ROAD 19423
SOUTH POINT OH
45680-8831
US

IV. Provider business mailing address

1404 RACE ST
CINCINNATI OH
45202-7297
US

V. Phone/Fax

Practice location:
  • Phone: 740-451-0741
  • Fax:
Mailing address:
  • Phone: 513-581-1531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2304613-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: