Provider Demographics
NPI:1699305557
Name:BALLARD, SHARONDA LAKIESHA
Entity type:Individual
Prefix:
First Name:SHARONDA
Middle Name:LAKIESHA
Last Name:BALLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 WESTLAKE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-4866
Mailing Address - Country:US
Mailing Address - Phone:910-867-4417
Mailing Address - Fax:910-302-7479
Practice Address - Street 1:245 WESTLAKE RD STE 101
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-4866
Practice Address - Country:US
Practice Address - Phone:910-867-4417
Practice Address - Fax:910-302-7479
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14863101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional