Provider Demographics
NPI:1235723016
Name:INGRAM, ANDRIA (MHC, CASAC-ADV)
Entity Type:Individual
Prefix:
First Name:ANDRIA
Middle Name:
Last Name:INGRAM
Suffix:
Gender:F
Credentials:MHC, CASAC-ADV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11440 VAN WYCK EXPY
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-2229
Mailing Address - Country:US
Mailing Address - Phone:718-322-3455
Mailing Address - Fax:718-322-3677
Practice Address - Street 1:11440 VAN WYCK EXPY
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-2229
Practice Address - Country:US
Practice Address - Phone:718-322-3455
Practice Address - Fax:718-322-3677
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35070101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)