Detraveus Ingram, CADC-R

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CADC-27212 Issued in NC

Practice address

20 Page Dr
Pinehurst, NC 28374-8847

Phone

(910) 235-9090

Fax

(910) 235-9093

NPI assigned

Mar 17, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: detraveus.ingram@ctcprograms.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ats of North Carolina, LLC

  • Methadone Clinic
  • Pinehurst, NC
  • NPI 1649310152

  Addiction (Substance Use Disorder)

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660262400000",
    "number": "1225786296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "377 NEEDMORE RD",
            "city": "CARTHAGE",
            "state": "NC",
            "postal_code": "283279245",
            "telephone_number": "910-638-2134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 PAGE DR",
            "city": "PINEHURST",
            "state": "NC",
            "postal_code": "283748847",
            "telephone_number": "910-235-9090",
            "fax_number": "910-235-9093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INGRAM",
        "first_name": "DETRAVEUS",
        "name_prefix": "Mr.",
        "credential": "CADC-R",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-03-17",
        "last_updated": "2022-08-12",
        "certification_date": "2022-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "CADC-27212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "DeTraveus.ingram@ctcprograms.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "20 Page Dr",
            "city": "Pinehurst",
            "state": "NC",
            "country_code": "US",
            "postal_code": "283748847",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Melisha Hunter
• Geena Huskey
• Bradley Len Icard
• Mir M Ikramullah, M.D.
• In Health, LLC
• Keosha Tyronda Ingram, CNM
• Moquesha Ingram
• Victoria Inness, V
• Ian Inquimboy, PT
• Integrated Wound Specialists of North Carolina, PLLC

• Addiction (Substance Use Disorder) Counselor in Pinehurst, NC
• Providers in Pinehurst, NC by specialty
• Addiction (Substance Use Disorder) Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.