=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952914988
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OPRAH INGRAM LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2020
-----------------------------------------------------
Last Update Date | 10/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 141 PARKER ST SUITE #306
-----------------------------------------------------
City | MAYNARD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-766-3761
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 313 DOVE RIDGE RD
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29223-5593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 8351
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------