Provider Demographics
NPI:1992216006
Name:INGRAM, WILLIAM ERIC (MSW, CSAC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ERIC
Last Name:INGRAM
Suffix:
Gender:M
Credentials:MSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 ROSEHILL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-5721
Mailing Address - Country:US
Mailing Address - Phone:704-560-7387
Mailing Address - Fax:704-786-1501
Practice Address - Street 1:35 MEANS AVE SE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-3563
Practice Address - Country:US
Practice Address - Phone:704-786-1500
Practice Address - Fax:704-786-1501
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1146654101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)