Provider Demographics
NPI:1295029908
Name:HUMPHRIES, ZARIA DAVIS (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:ZARIA
Middle Name:DAVIS
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6611 ALLNESS GLEN LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-6913
Mailing Address - Country:US
Mailing Address - Phone:704-380-1313
Mailing Address - Fax:
Practice Address - Street 1:6611 ALLNESS GLEN LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-6913
Practice Address - Country:US
Practice Address - Phone:704-380-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9117104100000X
NCC0064691041C0700X
OHI.08000781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker