Provider Demographics
NPI:1699986539
Name:BROCKINGTON, INGA A (LCADC/ PASTORAL CARE)
Entity type:Individual
Prefix:DR
First Name:INGA
Middle Name:A
Last Name:BROCKINGTON
Suffix:
Gender:F
Credentials:LCADC/ PASTORAL CARE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114R RADCLIFFE ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-5012
Mailing Address - Country:US
Mailing Address - Phone:215-376-4158
Mailing Address - Fax:
Practice Address - Street 1:114R RADCLIFFE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-5012
Practice Address - Country:US
Practice Address - Phone:215-376-4158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty