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NPI Code Detail

MEDICARE: KELLY HUMES LCSW

MEDICARE: KELLY HUMES LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker0904012842VA
2101YM0800XMental Health CounselorVA

General Provider Information

NPI Number : 1902489875
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY HUMES LCSW
Provider Business Mailing Address
First Line : PO BOX 2549
Second Line :
City : GLEN ALLEN
State : VA
Zip : 23058-2549
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2604 N PARHAM RD
Second Line :
City : RICHMOND
State : VA
Zip : 23294-4649
Country : US
Telephone Number : 804-230-0999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2021
Last Update Date : 02/21/2025

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