Provider Demographics
NPI:1295495604
Name:INGRAM, ASHLEY EVONNE
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:EVONNE
Last Name:INGRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 ROYAL ANNE LN APT 204
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-7813
Mailing Address - Country:US
Mailing Address - Phone:919-906-2997
Mailing Address - Fax:
Practice Address - Street 1:615 WHEAT MILL RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1242
Practice Address - Country:US
Practice Address - Phone:919-491-8611
Practice Address - Fax:919-937-2046
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-27
Last Update Date:2022-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No175T00000XOther Service ProvidersPeer Specialist