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General NPI Number Information
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NPI Number | 1538671839
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Entity Type | Individual
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Provider Name | REGENA M HUMPHRIES LICSW, LCSW, LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 10/26/2017
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Last Update Date | 10/26/2017
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Provider Practice Location Address
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Address Line | 1727 KING ST STE 105
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City | ALEXANDRIA
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State | VA
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Zip | 22314-2700
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Country | US
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Telephone | 703-831-7872
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Fax |
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Provider Business Mailing Address
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Address Line | 14011 WHEEL WRIGHT PL
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City | ACCOKEEK
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State | MD
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Zip | 20607-3794
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Country | US
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Telephone | 202-487-9264
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Fax |
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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 | 13950
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC50079777
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904010169
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License Number State | VA
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