Healthcare Provider Details

I. General information

NPI: 1184064891
Provider Name (Legal Business Name): JUDITHE LOUIS-INGRAM LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUDITHE LOUIS

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 10/04/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 BLACKWELL ST STE 900
DURHAM NC
27701-3659
US

IV. Provider business mailing address

324 BLACKWELL ST STE 900
DURHAM NC
27701-3659
US

V. Phone/Fax

Practice location:
  • Phone: 980-230-1263
  • Fax:
Mailing address:
  • Phone: 980-230-1263
  • Fax: 980-448-3832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-23485
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP018933
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberP018933
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP018933
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: