Basic Information
| Provider Information | |||||||||
| NPI: | 1801382957 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | INGRAM | ||||||||
| FirstName: | BRIDGET | ||||||||
| MiddleName: | LUCINDA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4571 HIGHWAY 230 | ||||||||
| Address2: | |||||||||
| City: | WALNUT RIDGE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703162183 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 503 SE LINDSEY ST | ||||||||
| Address2: | |||||||||
| City: | HOXIE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724332224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8708861333 | ||||||||
| FaxNumber: | 8708861334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2018 | ||||||||
| LastUpdateDate: | 09/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 8908-M | AR | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 8908-C | AR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.