Provider Demographics
NPI:1598871113
Name:INGE, MARY JOELLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JOELLE
Last Name:INGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:JOELLE
Other - Last Name:INGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2727 ELECTRIC RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3547
Mailing Address - Country:US
Mailing Address - Phone:540-772-5153
Mailing Address - Fax:540-772-5157
Practice Address - Street 1:2727 ELECTRIC RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3547
Practice Address - Country:US
Practice Address - Phone:540-772-5153
Practice Address - Fax:540-772-5157
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040048511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical