Provider Demographics
NPI:1861838948
Name:INGRAM, TACARRA (MSW, LCSW, LCASA)
Entity Type:Individual
Prefix:MRS
First Name:TACARRA
Middle Name:
Last Name:INGRAM
Suffix:
Gender:F
Credentials:MSW, LCSW, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 958
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-0958
Mailing Address - Country:US
Mailing Address - Phone:919-877-6442
Mailing Address - Fax:919-887-0479
Practice Address - Street 1:6034 RIVER LAKE CIR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-6000
Practice Address - Country:US
Practice Address - Phone:919-335-6038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3316-A101YA0400X
NCC0140291041C0700X
NC12030571041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool