Provider Demographics
NPI:1376430249
Name:P CRUZ, INGRID P
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:P
Last Name:P CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 BLACKWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-4905
Mailing Address - Country:US
Mailing Address - Phone:770-940-1445
Mailing Address - Fax:
Practice Address - Street 1:2795 MAIN STREET WEST, SUITE 20B
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078
Practice Address - Country:US
Practice Address - Phone:678-344-7836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor