Provider Demographics
NPI:1053104497
Name:INGRAM-HINES, DEMETRIA Y
Entity type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:Y
Last Name:INGRAM-HINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEMETRIA
Other - Middle Name:Y
Other - Last Name:INGRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27125 LANCASTER DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48134-9068
Mailing Address - Country:US
Mailing Address - Phone:313-615-6741
Mailing Address - Fax:
Practice Address - Street 1:3011 W GRAND BLVD STE 200
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3068
Practice Address - Country:US
Practice Address - Phone:313-573-8523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker