Individual
ATHALIAH INGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1777 AXTELL DR STE 100, TROY, MI 48084-4400
(248) 787-0855
Mailing address
596 MARQUETTE DR, DETROIT, MI 48214-3640
(313) 461-9792
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6362009351
MI
Other
Enumeration date
09/07/2021
Last updated
09/07/2021
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