Provider Demographics
NPI:1275059685
Name:INGRAM-PATTERSON, SHARETTA LANOR
Entity Type:Individual
Prefix:MRS
First Name:SHARETTA
Middle Name:LANOR
Last Name:INGRAM-PATTERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11365 111TH AVE
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-3706
Mailing Address - Country:US
Mailing Address - Phone:484-843-6610
Mailing Address - Fax:
Practice Address - Street 1:11365 111TH AVENUE
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778
Practice Address - Country:US
Practice Address - Phone:484-843-6610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)