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NPI Code Detail

MEDICARE: LATORIA INGRAM

MEDICARE: LATORIA INGRAM
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
1101YM0800XMental Health CounselorA21125NC

General Provider Information

NPI Number : 1912768912
Entity Type Code : Individual
Provider Name (Legal Business Name) : LATORIA INGRAM
Provider Business Mailing Address
First Line : 5330 RAEFORD RD
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28304-3074
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5330 RAEFORD RD
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28304-3074
Country : US
Telephone Number : 910-222-8021
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2024
Last Update Date : 02/23/2026

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Directions to “ LATORIA INGRAM ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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