Provider Demographics
NPI:1922631548
Name:INGRAM, ERIKA (MED, MSED)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:INGRAM
Suffix:
Gender:F
Credentials:MED, MSED
Other - Prefix:MS
Other - First Name:ERIKA
Other - Middle Name:
Other - Last Name:COLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, MSED
Mailing Address - Street 1:115 OLE CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-6736
Mailing Address - Country:US
Mailing Address - Phone:347-722-2442
Mailing Address - Fax:
Practice Address - Street 1:115 OLE CEDAR LN
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-6736
Practice Address - Country:US
Practice Address - Phone:347-722-2442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst