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1891961124
MICHAEL INGRAM
SANTA ROSA, CA
NPI
1891961124
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2008-05-06
Last Update Date
2008-05-06
Business Address
-- MICHAEL INGRAM
1300 CODDINGTOWN CTR
SANTA ROSA, CA 95401-3537
Phone number: 707-565-7649
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Mailing Address
-- MICHAEL INGRAM
1300 CODDINGTOWN CTR
SANTA ROSA, CA 95401-3537
Phone number: 707-565-7649
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