Doctor Name: | DR. CONNIE L INGRAM |
NPI Number: | 1134456494 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | MH3539 |
Business Practice Address: | 1402 Royal Palm Beach Blvd Suite 400b Royal Palm Beach, FL - 334111691 |
Business Phone Number: | 5617929242 |
Business Fax Number: | 5617929243 |
Mailing Address: | 1402 Royal Palm Beach Blvd, Suite 400b ROYAL PALM BEACH |
State: | FL |
Postal Code: | 334111691 |
Phone Number: | 5617929242 |
Fax Number: | 5617929243 |
NPI Enumeration Date: | 11/06/2009 |
NPI Last Update Date: | 11/06/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH3539 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |