MEDICARE: ANNA CUNNINGHAM INGRAM LPC

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	101YP2500X	Professional Counselor	LPC011424	GA

General Provider Information

NPI Number	:	1962036996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA CUNNINGHAM INGRAM LPC

Provider Business Mailing Address
First Line	:	65 SAVANNAH CIRCLE
Second Line	:	COVINGTON
City	:	COVINGTON
State	:	GA
Zip	:	30016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1808 OVER LAKE DR SE STE D
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-6608
Country	:	US
Telephone Number	:	770-648-1308
Fax Number	:

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

Provider Enumeration Date	:	02/28/2020
Last Update Date	:	11/08/2024

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