Theresa Ballas, LAC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

37AC00300100 Issued in NJ

Practice address

42 Delsea Dr S
Glassboro, NJ 08028-2621

Phone

(856) 881-8689

Fax

(856) 881-5508

NPI assigned

Aug 31, 2016

Last updated

Aug 31, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472601600000",
    "number": "1073069985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42 DELSEA DR S",
            "city": "GLASSBORO",
            "state": "NJ",
            "postal_code": "080282621",
            "telephone_number": "856-881-8689",
            "fax_number": "856-881-5508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 DELSEA DR S",
            "city": "GLASSBORO",
            "state": "NJ",
            "postal_code": "080282621",
            "telephone_number": "856-881-8689",
            "fax_number": "856-881-5508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLAS",
        "first_name": "THERESA",
        "credential": "LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-31",
        "last_updated": "2016-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NJ",
            "license": "37AC00300100",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NJ",
            "license": "101YP2500X",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Glassboro, NJ
• Providers in Glassboro, NJ by specialty
• Professional Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.