MEDICARE: ASHLEY KING BALLANCIER LMHP-R

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1033009378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY KING BALLANCIER LMHP-R

Provider Business Mailing Address
First Line	:	15111 ELLICOTT DR APT 207
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23114-6840
Country	:	US
Telephone Number	:	347-608-7406
Fax Number	:

Provider Business Practice Location Address
First Line	:	9211 FOREST HILL AVE STE 204
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-6877
Country	:	US
Telephone Number	:	347-608-7406
Fax Number	:

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

Provider Enumeration Date	:	07/08/2025
Last Update Date	:	07/08/2025

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