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General NPI Number Information
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NPI Number | 1972398345
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Entity Type | Individual
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Provider Name | HERBERT WAYNE BALLARD III
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Gender | Male
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Dates
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Enumeration Date | 04/14/2025
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 504 N GRAND TRAVERSE ST
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City | FLINT
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State | MI
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Zip | 48503-2536
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Country | US
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Telephone | 810-487-4676
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Fax |
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Provider Business Mailing Address
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Address Line | 5099 W FARRAND RD
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City | CLIO
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State | MI
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Zip | 48420-8215
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Country | US
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Telephone | 586-491-1057
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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