Provider Demographics
NPI:1629412770
Name:INGRAM, VASHTI B (LGSW)
Entity Type:Individual
Prefix:
First Name:VASHTI
Middle Name:B
Last Name:INGRAM
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10610 BICKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3976
Mailing Address - Country:US
Mailing Address - Phone:301-758-5228
Mailing Address - Fax:
Practice Address - Street 1:415 MICHIGAN AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-4500
Practice Address - Country:US
Practice Address - Phone:202-488-3990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool