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General NPI Number Information
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NPI Number | 1043525447
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Entity Type | Individual
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Provider Name | ANDREW DWIGHT HUMPHRIES LMSW
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Gender | Male
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Dates
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Enumeration Date | 08/10/2010
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 1700 WATERMAN ST
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City | DETROIT
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State | MI
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Zip | 48209-2022
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Country | US
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Telephone | 313-841-8900
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Fax | 313-841-3756
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Provider Business Mailing Address
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Address Line | 5115 GRAYTON ST
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City | DETROIT
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State | MI
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Zip | 48224-2147
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Country | US
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Telephone | 313-806-6711
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Fax | 313-885-5059
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801082960
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License Number State | MI
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