Provider Demographics
NPI:1902209430
Name:SHEPARD-INGRAM, EVA (BS, MS)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:SHEPARD-INGRAM
Suffix:
Gender:F
Credentials:BS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 TOWN CRIER DR
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-8669
Mailing Address - Country:US
Mailing Address - Phone:802-258-4623
Mailing Address - Fax:
Practice Address - Street 1:10 SCHOOL ST APT 1
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NH
Practice Address - Zip Code:03465-2144
Practice Address - Country:US
Practice Address - Phone:603-213-0882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NH1549101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)