Healthcare Provider Details

I. General information

NPI: 1013229186
Provider Name (Legal Business Name): LYNN INGRAM LPA, HSP-PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 S 2ND ST
WILMINGTON NC
28401-5068
US

IV. Provider business mailing address

PO BOX 1473
WILMINGTON NC
28402-1473
US

V. Phone/Fax

Practice location:
  • Phone: 910-448-0728
  • Fax:
Mailing address:
  • Phone: 910-448-0728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3962
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number3962
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3962
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3962
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number3962
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: