Provider Demographics
NPI:1821782020
Name:INGRAM, LADREA R (EDD, CHES, CADC)
Entity Type:Individual
Prefix:
First Name:LADREA
Middle Name:R
Last Name:INGRAM
Suffix:
Gender:F
Credentials:EDD, CHES, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11514 WHIMBREL CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-0088
Mailing Address - Country:US
Mailing Address - Phone:704-249-6715
Mailing Address - Fax:
Practice Address - Street 1:11514 WHIMBREL CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-0088
Practice Address - Country:US
Practice Address - Phone:704-249-6715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18606101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor