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NPI Code Detail

MEDICARE: PRISCILLA L BALLSUN LCSW

MEDICARE:   PRISCILLA L BALLSUN  LCSW
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
11041C0700XClinical Social WorkerLC302148DC
21041C0700XClinical Social Worker0904015883VA

General Provider Information

NPI Number : 1699767558
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRISCILLA L BALLSUN LCSW
Provider Business Mailing Address
First Line : 575 LYNNHAVEN PKWY STE 305
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23452-7350
Country : US
Telephone Number : 804-207-6737
Fax Number :
Provider Business Practice Location Address
First Line : 575 LYNNHAVEN PKWY STE 305
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23452-7350
Country : US
Telephone Number : 804-207-6737
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2005
Last Update Date : 07/21/2025

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Directions to “ PRISCILLA L BALLSUN LCSW” Practice Location

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