MEDICARE: LADREA R INGRAM EDD, CHES, CADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	A18606	NC

General Provider Information

NPI Number	:	1821782020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LADREA R INGRAM EDD, CHES, CADC

Provider Business Mailing Address
First Line	:	11514 WHIMBREL CT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-0088
Country	:	US
Telephone Number	:	704-249-6715
Fax Number	:

Provider Business Practice Location Address
First Line	:	11514 WHIMBREL CT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-0088
Country	:	US
Telephone Number	:	704-249-6715
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2023
Last Update Date	:	06/08/2023

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