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General NPI Number Information
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NPI Number | 1972328219
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Entity Type | Individual
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Provider Name | ELLIOTT HUMPHRIES
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Gender | Male
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 618 N HOWE ST
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City | SOUTHPORT
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State | NC
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Zip | 28461-3426
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Country | US
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Telephone | 336-346-4386
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Fax | 743-208-6507
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Provider Business Mailing Address
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Address Line | 2207 DELANEY DR STE 206
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City | BURLINGTON
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State | NC
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Zip | 27215-5263
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Country | US
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Telephone | 336-346-4386
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Fax | 743-208-6507
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A20914
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License Number State | NC
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