| NPI | 1932279478 |
|---|---|
| Former Name | JEANNA MARIE INGRAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 3628) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 3628) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2007-07-08 |