Provider Demographics
NPI:1043525447
Name:HUMPHRIES, ANDREW DWIGHT (LMSW)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:DWIGHT
Last Name:HUMPHRIES
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 GRAYTON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-2147
Mailing Address - Country:US
Mailing Address - Phone:313-806-6711
Mailing Address - Fax:313-885-5059
Practice Address - Street 1:1700 WATERMAN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-2022
Practice Address - Country:US
Practice Address - Phone:313-841-8900
Practice Address - Fax:313-841-3756
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010829601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical