Provider Demographics
NPI:1801382957
Name:INGRAM, BRIDGET LUCINDA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:LUCINDA
Last Name:INGRAM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4571 HIGHWAY 230
Mailing Address - Street 2:
Mailing Address - City:WALNUT RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72476
Mailing Address - Country:US
Mailing Address - Phone:870-316-2183
Mailing Address - Fax:
Practice Address - Street 1:503 SE LINDSEY ST
Practice Address - Street 2:
Practice Address - City:HOXIE
Practice Address - State:AR
Practice Address - Zip Code:72433-2224
Practice Address - Country:US
Practice Address - Phone:870-886-1333
Practice Address - Fax:870-886-1334
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8908-M104100000X
AR8908-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker