Provider Demographics
NPI:1629861513
Name:INGRAM, LEAH GRACE (APCC)
Entity type:Individual
Prefix:MS
First Name:LEAH GRACE
Middle Name:
Last Name:INGRAM
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 N REDWOOD DR STE 225
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1972
Mailing Address - Country:US
Mailing Address - Phone:415-234-3775
Mailing Address - Fax:
Practice Address - Street 1:175 N REDWOOD DR STE 225
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1972
Practice Address - Country:US
Practice Address - Phone:415-234-3775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor