Basic Information
| Provider Information | |||||||||
| NPI: | 1710145024 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | INGRAM | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | PERRY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCSW, LCAS-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 603 EASTWAY AVE | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277032003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194912940 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1101 WEAVER DAIRY RD STE 103 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275141791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9849746320 | ||||||||
| FaxNumber: | 9849746447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2008 | ||||||||
| LastUpdateDate: | 02/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C006658 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.