Provider Demographics
NPI:1063037919
Name:INGRAM, ERIN NICOLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:NICOLE
Last Name:INGRAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 HIGHWAY 39
Mailing Address - Street 2:
Mailing Address - City:INGRAM
Mailing Address - State:TX
Mailing Address - Zip Code:78025-3273
Mailing Address - Country:US
Mailing Address - Phone:830-367-1990
Mailing Address - Fax:
Practice Address - Street 1:304 HIGHWAY 39
Practice Address - Street 2:
Practice Address - City:INGRAM
Practice Address - State:TX
Practice Address - Zip Code:78025-3273
Practice Address - Country:US
Practice Address - Phone:830-367-1990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX622681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty