Individual
MR. DETRAVEUS INGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC-R
Contact information
Practice address
20 PAGE DR, PINEHURST, NC 28374-8847
(910) 235-9090
(910) 235-9093
Mailing address
377 NEEDMORE RD, CARTHAGE, NC 28327-9245
(910) 638-2134
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CADC-27212
NC
Other
Enumeration date
03/17/2022
Last updated
08/12/2022
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