Provider Demographics
NPI:1184064891
Name:LOUIS-INGRAM, JUDITHE (LCSWA)
Entity type:Individual
Prefix:
First Name:JUDITHE
Middle Name:
Last Name:LOUIS-INGRAM
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:JUDITHE
Other - Middle Name:
Other - Last Name:LOUIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5200 PARK RD STE 218B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3650
Mailing Address - Country:US
Mailing Address - Phone:866-700-1606
Mailing Address - Fax:
Practice Address - Street 1:201 W MAIN ST STE 316
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3228
Practice Address - Country:US
Practice Address - Phone:980-230-1263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0189331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical