Provider Demographics
NPI:1174358808
Name:HUMPHREY, EUNICE Y (EDD, LCPC, ACS)
Entity type:Individual
Prefix:DR
First Name:EUNICE
Middle Name:Y
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:EDD, LCPC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2832 COPPERSMITH PL
Mailing Address - Street 2:
Mailing Address - City:BRYANS ROAD
Mailing Address - State:MD
Mailing Address - Zip Code:20616-7025
Mailing Address - Country:US
Mailing Address - Phone:240-423-1738
Mailing Address - Fax:
Practice Address - Street 1:2832 COPPERSMITH PL
Practice Address - Street 2:
Practice Address - City:BRYANS ROAD
Practice Address - State:MD
Practice Address - Zip Code:20616-7025
Practice Address - Country:US
Practice Address - Phone:240-423-1738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8132101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health