Healthcare Provider Details

I. General information

NPI: 1528628211
Provider Name (Legal Business Name): ALLANA DEIDRE INGRAM BSC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2019
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 N DIXIE HWY
POMPANO BEACH FL
33060-5621
US

IV. Provider business mailing address

3532 N UNIVERSITY DR
CORAL SPRINGS FL
33065-1649
US

V. Phone/Fax

Practice location:
  • Phone: 954-785-8285
  • Fax:
Mailing address:
  • Phone: 305-690-2556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: