Provider Demographics
NPI:1134379266
Name:INGRAM-CANTY, YETTA (MHC)
Entity type:Individual
Prefix:MRS
First Name:YETTA
Middle Name:
Last Name:INGRAM-CANTY
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2088 SHELBY ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31903-3010
Mailing Address - Country:US
Mailing Address - Phone:706-256-3212
Mailing Address - Fax:706-256-0124
Practice Address - Street 1:2088 SHELBY ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31903-3010
Practice Address - Country:US
Practice Address - Phone:706-256-3212
Practice Address - Fax:706-256-0124
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor