Provider Demographics
NPI:1386883312
Name:BALLIVIERO, DINO DOMINIC (LPC, CTTS)
Entity type:Individual
Prefix:MR
First Name:DINO
Middle Name:DOMINIC
Last Name:BALLIVIERO
Suffix:
Gender:M
Credentials:LPC, CTTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 LEEDS ST
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5061
Mailing Address - Country:US
Mailing Address - Phone:985-643-3669
Mailing Address - Fax:985-643-3669
Practice Address - Street 1:71338 HWY. 21
Practice Address - Street 2:SUITE 101
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7162
Practice Address - Country:US
Practice Address - Phone:985-624-2942
Practice Address - Fax:985-231-1373
Is Sole Proprietor?:No
Enumeration Date:2009-02-15
Last Update Date:2020-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2732101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LALPC2732OtherPROFESSIONAL LICENSE