Provider Demographics
NPI:1508627035
Name:INGRAM, NANETTE MARILYN (CLC, MLC)
Entity Type:Individual
Prefix:MRS
First Name:NANETTE
Middle Name:MARILYN
Last Name:INGRAM
Suffix:
Gender:F
Credentials:CLC, MLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5907 MONTPELIER DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-8122
Mailing Address - Country:US
Mailing Address - Phone:951-905-8209
Mailing Address - Fax:
Practice Address - Street 1:5907 MONTPELIER DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-8122
Practice Address - Country:US
Practice Address - Phone:951-905-8209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL330626174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist