Provider Demographics
NPI:1497170716
Name:HUMPHREY, TERRA (CACII)
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 OLD PARKER RD SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-6239
Mailing Address - Country:US
Mailing Address - Phone:678-374-2959
Mailing Address - Fax:404-975-4376
Practice Address - Street 1:1990 OLD PARKER RD SE
Practice Address - Street 2:SUITE 100
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-6239
Practice Address - Country:US
Practice Address - Phone:678-374-2959
Practice Address - Fax:404-975-4376
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)