Provider Demographics
NPI:1407928997
Name:INGRAM, MARY VICTORIA (PSYD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:VICTORIA
Last Name:INGRAM
Suffix:
Gender:F
Credentials:PSYD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5417 WOODVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1400
Mailing Address - Country:US
Mailing Address - Phone:910-717-7801
Mailing Address - Fax:
Practice Address - Street 1:NORMANDY DRIVE BUILDING 4-2817
Practice Address - Street 2:WAMC DEPT. OF BEHAVIORAL HEALTH
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28307
Practice Address - Country:US
Practice Address - Phone:910-907-8679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000953103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical