Provider Demographics
NPI:1790861607
Name:CIUCEVICH, INGRID WARD (LPC)
Entity Type:Individual
Prefix:MS
First Name:INGRID
Middle Name:WARD
Last Name:CIUCEVICH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 11TH AVE S STE 325
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-2823
Mailing Address - Country:US
Mailing Address - Phone:205-322-8002
Mailing Address - Fax:205-322-8092
Practice Address - Street 1:2112 11TH AVE S STE 325
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-2823
Practice Address - Country:US
Practice Address - Phone:205-322-8002
Practice Address - Fax:205-322-8092
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL404101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional