Healthcare Provider Details

I. General information

NPI: 1568180537
Provider Name (Legal Business Name): KATHRYN G INGRAM MSW, LCSW-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATIE G INGRAM

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 E NC HIGHWAY 54 STE 240
DURHAM NC
27713-2263
US

IV. Provider business mailing address

1920 E NC HIGHWAY 54 STE 240
DURHAM NC
27713-2263
US

V. Phone/Fax

Practice location:
  • Phone: 919-378-1340
  • Fax: 888-975-6815
Mailing address:
  • Phone: 919-378-1340
  • Fax: 888-975-6815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC018961
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: