Individual
MICAH INGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CDCA
Contact information
Practice address
4930 ENTERPRISE DR NW, WARREN, OH 44481-8706
(330) 787-0955
Mailing address
4930 ENTERPRISE DR NW, WARREN, OH 44481-8706
(330) 787-0955
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
177947
OH
Other
Enumeration date
08/18/2021
Last updated
08/18/2021
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