MEDICARE: MR. THOMAS ANTHONY BALLIS LCSW, LCAS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	447	NC
2	1041C0700X	Clinical Social Worker	C002121	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982707279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS ANTHONY BALLIS LCSW, LCAS

Provider Business Mailing Address
First Line	:	720 N 3RD ST
Second Line	:	STE 101
City	:	WILMINGTON
State	:	NC
Zip	:	28401-3474
Country	:	US
Telephone Number	:	910-251-2106
Fax Number	:	910-251-7859

Provider Business Practice Location Address
First Line	:	720 N 3RD ST
Second Line	:	STE 101
City	:	WILMINGTON
State	:	NC
Zip	:	28401-3474
Country	:	US
Telephone Number	:	910-251-2106
Fax Number	:	910-251-7859

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

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	01/22/2019

Similar Medicare Providers

1225972912 — INSIGHT WELLNESS SERVICES PC
Practice Location Address:

720 N 3RD ST STE 101
WILMINGTON, NC
28401-3474

Practice Phone: 910-251-2106
Practice Fax: 910-251-7859

1487051561 — MARY D WISECUP MSW, LCSW
Practice Location Address:

720 N 3RD ST STE 101
WILMINGTON, NC
28401-3474

Practice Phone: 910-632-2191
Practice Fax: 919-251-7859

1831682665 — FAMILY TIES OF BRUNSWICK, LLC
Practice Location Address:

720 N 3RD ST STE 401
WILMINGTON, NC
28401-3474

Practice Phone: 910-769-9126
Practice Fax: 910-769-9169

1447850458 — MRS. HEATHER BLACK FNP-BC, PMHNP
Practice Location Address:

720 N 3RD ST STE 401
WILMINGTON, NC
28401-3474

Practice Phone: 910-769-9126
Practice Fax:

1659057172 — JENNIFER KEEVER PETERKEN MSW, LCSWA
Practice Location Address:

720 N 3RD ST STE 401
WILMINGTON, NC
28401-3474

Practice Phone: 910-769-9126
Practice Fax:

1548049968 — JEANNE MARSHALL PLLC
Practice Location Address:

720 N 3RD ST STE 101
WILMINGTON, NC
28401-3474

Practice Phone: 860-710-2507
Practice Fax: 910-251-7859

Directions to “ MR. THOMAS ANTHONY BALLIS LCSW, LCAS” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.