Individual
INGRAM MALCOLM KERRY DIRTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2102 W BETHANY HOME RD, PHOENIX, AZ 85015-1935
(602) 774-4745
Mailing address
708 S LINDON LN APT 5020A, TEMPE, AZ 85281-3221
(864) 979-1325
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LAC-08076T
AZ
Other
Enumeration date
12/21/2023
Last updated
12/21/2023
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