Provider Demographics
NPI:1285162461
Name:BALLARD-GREEN, DANIELLE KATRINA WACHTEL (LMSW, CADC)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:KATRINA WACHTEL
Last Name:BALLARD-GREEN
Suffix:
Gender:F
Credentials:LMSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 CARPENTER AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311-2860
Mailing Address - Country:US
Mailing Address - Phone:515-298-2020
Mailing Address - Fax:
Practice Address - Street 1:3116 CARPENTER AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50311-2860
Practice Address - Country:US
Practice Address - Phone:515-298-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA12112101YA0400X
IA0867591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)