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General NPI Number Information
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NPI Number | 1922297787
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Entity Type | Individual
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Provider Name | GREGORY INGRAM LICSW
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Gender | Male
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 03/12/2019
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Provider Practice Location Address
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Address Line | 8506 SCHULTZ RD
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City | CLINTON
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State | MD
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Zip | 20735-2662
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Country | US
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Telephone | 202-297-9992
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Fax |
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Provider Business Mailing Address
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Address Line | 6856 EASTERN AVE NW 286
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City | WASHINGTON
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State | DC
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Zip | 20012-2165
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Country | US
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Telephone | 202-723-6600
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Fax | 202-723-2549
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LG102351
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License Number State | DC
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