Provider Demographics
NPI:1508259011
Name:INGRAM, ZANDRIA (LCSW)
Entity Type:Individual
Prefix:
First Name:ZANDRIA
Middle Name:
Last Name:INGRAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ZANDRIA
Other - Middle Name:
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:5205 S 86TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-7133
Mailing Address - Country:US
Mailing Address - Phone:850-508-4717
Mailing Address - Fax:813-544-7503
Practice Address - Street 1:5205 S 86TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-7133
Practice Address - Country:US
Practice Address - Phone:813-547-6714
Practice Address - Fax:813-544-7503
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-08
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW87551041C0700X
FLSW187631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical