Provider Demographics
NPI:1710145024
Name:INGRAM, JAMIE PERRY (LCSW, LCAS-A)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:PERRY
Last Name:INGRAM
Suffix:
Gender:F
Credentials:LCSW, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 EASTWAY AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-2003
Mailing Address - Country:US
Mailing Address - Phone:919-491-2940
Mailing Address - Fax:
Practice Address - Street 1:1101 WEAVER DAIRY RD STE 103
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-1791
Practice Address - Country:US
Practice Address - Phone:984-974-6320
Practice Address - Fax:984-974-6447
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0066581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical