| Doctor Name: | WHITNEY BALLIETT |
| NPI Number: | 1558749945 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LADC |
| License Number: | 1038 |
| Business Practice Address: | 187 S Canaan Rd Canaan, CT - 060182544 |
| Business Phone Number: | 8608241397 |
| Business Fax Number: | |
| Mailing Address: | Po Box 717, CANAAN |
| State: | CT |
| Postal Code: | 060180717 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 05/18/2015 |
| NPI Last Update Date: | 05/18/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 1038 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |