Provider Demographics
NPI:1013799329
Name:INGRAM, LILLIAN YVONNE (LICSW)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:YVONNE
Last Name:INGRAM
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17013 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:SPENCERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20868-3105
Mailing Address - Country:US
Mailing Address - Phone:202-714-6012
Mailing Address - Fax:
Practice Address - Street 1:17013 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:SPENCERVILLE
Practice Address - State:MD
Practice Address - Zip Code:20868-3105
Practice Address - Country:US
Practice Address - Phone:202-714-6012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3005891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical