Provider Demographics
NPI:1477969707
Name:INGRAM, BRANDY LATASHA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:LATASHA
Last Name:INGRAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:LATASHA
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5868 CREEK STATION DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8627
Mailing Address - Country:US
Mailing Address - Phone:850-478-1244
Mailing Address - Fax:
Practice Address - Street 1:5868 CREEK STATION DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8627
Practice Address - Country:US
Practice Address - Phone:850-478-1244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW124671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical