Provider Demographics
NPI:1588984769
Name:BALLARD, RAFFAELA (CADC)
Entity type:Individual
Prefix:
First Name:RAFFAELA
Middle Name:
Last Name:BALLARD
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 COLLEGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-8713
Mailing Address - Country:US
Mailing Address - Phone:302-735-7790
Mailing Address - Fax:302-735-3654
Practice Address - Street 1:111 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:DE
Practice Address - Zip Code:19956-1004
Practice Address - Country:US
Practice Address - Phone:302-877-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE600101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)