| Doctor Name: | DOUGLAS WAYNE BALLAGH |
| NPI Number: | 1013286624 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.C.S.W. |
| License Number: | LCS16576 |
| Business Practice Address: | Highway 1 San Luis Obispo, CA - 934090001 |
| Business Phone Number: | 8055477900 |
| Business Fax Number: | |
| Mailing Address: | 2109 Laguna Negra Ln, ARROYO GRANDE |
| State: | CA |
| Postal Code: | 934209653 |
| Phone Number: | 8053430225 |
| Fax Number: | |
| NPI Enumeration Date: | 12/28/2011 |
| NPI Last Update Date: | 12/28/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LCS16576 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |