Provider Demographics
NPI:1689403644
Name:BALL, COLBY (MA)
Entity type:Individual
Prefix:
First Name:COLBY
Middle Name:
Last Name:BALL
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S 47TH ST APT 203
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3651
Mailing Address - Country:US
Mailing Address - Phone:615-983-0854
Mailing Address - Fax:
Practice Address - Street 1:650 NAAMANS RD STE 110
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-2301
Practice Address - Country:US
Practice Address - Phone:615-983-0854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
DEAC-0010474101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health