Individual
LISA DIANNE BALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PROVISIONAL LPC
Contact information
Practice address
120 PROFESSIONAL PL, BRIDGEPORT, WV 26330-4599
(304) 460-5123
Mailing address
120 PROFESSIONAL PL, BRIDGEPORT, WV 26330-4599
(304) 460-5123
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
772
WV
Other
Enumeration date
12/07/2022
Last updated
04/24/2023
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