Provider Demographics
NPI:1043824675
Name:INGRAM, KESHIA DIANE (MA,LPC)
Entity Type:Individual
Prefix:MRS
First Name:KESHIA
Middle Name:DIANE
Last Name:INGRAM
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4A DORSEY RD
Mailing Address - Street 2:APT A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606
Mailing Address - Country:US
Mailing Address - Phone:757-239-1786
Mailing Address - Fax:
Practice Address - Street 1:714 J CLYDE MORRIS BLVD STE 180
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1535
Practice Address - Country:US
Practice Address - Phone:757-706-3309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty