Provider Demographics
NPI:1366711855
Name:INGRAM, TERESA JEAN (LCSW)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:JEAN
Last Name:INGRAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:JEAN
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3903 PADDLEWHEEL CT
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-7959
Mailing Address - Country:US
Mailing Address - Phone:480-220-8926
Mailing Address - Fax:802-208-9264
Practice Address - Street 1:3903 PADDLEWHEEL CT
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-7959
Practice Address - Country:US
Practice Address - Phone:480-220-8926
Practice Address - Fax:802-208-9264
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW165701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty