Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 3962 | NC |
N | 103T00000X | Psychologist | 3962 | NC |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 3962 | NC |
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 3962 | NC |
N | 103G00000X | Clinical Psychologist | 3962 | NC |
N | 103TC0700X | Clinical Psychologist | 3962 | NC |
N | 103TC1900X | Counseling Psychologist | 3962 | NC |
NPI | 1013229186 |
---|---|
Provider Name | Ms. Lynn Ingram |
First Address | Wilmington, NC 28402-1473 |
Second Address | Wilmington, NC 28401-5068 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2010 |
Last Update Date | 15/04/2020 |