Provider Demographics
NPI:1144471046
Name:INGRAM, JOANNE K (LMSW)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:K
Last Name:INGRAM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 E KEARSLEY ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-6119
Mailing Address - Country:US
Mailing Address - Phone:810-262-0633
Mailing Address - Fax:810-885-0236
Practice Address - Street 1:914 E KEARSLEY ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-6119
Practice Address - Country:US
Practice Address - Phone:810-262-0633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010871921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801087192OtherMICHIGAN DEPARTMENT OF COMMUNITY HEALTH