Provider Demographics
NPI:1467141945
Name:HUMPHREY, MARGARET W (EDS, LPES, NCSP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:W
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:EDS, LPES, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 HORSESHOE BND
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7406
Mailing Address - Country:US
Mailing Address - Phone:864-706-7621
Mailing Address - Fax:
Practice Address - Street 1:1031 CHUCK DAWLEY BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4188
Practice Address - Country:US
Practice Address - Phone:864-706-7621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4578103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist