MEDICARE: MR. INGRID AMERICA NCC LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	LCPC18	MD

General Provider Information

NPI Number	:	1982674313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. INGRID AMERICA NCC LCPC

Provider Business Mailing Address
First Line	:	975 SOLOMONS ISLAND RD N
Second Line	:	PO BOX 980
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-3917
Country	:	US
Telephone Number	:	410-535-5400
Fax Number	:	410-414-9413

Provider Business Practice Location Address
First Line	:	975 SOLOMONS ISLAND RD N
Second Line	:
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-3917
Country	:	US
Telephone Number	:	410-535-5400
Fax Number	:	410-414-9413

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	07/08/2007

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