Provider Demographics
NPI:1528367554
Name:STAUNCH-HUMPHRIES, ASHLEA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEA
Middle Name:
Last Name:STAUNCH-HUMPHRIES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:ASHLEA
Other - Middle Name:
Other - Last Name:STAUNCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:217 LARKIN ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2536
Mailing Address - Country:US
Mailing Address - Phone:252-725-1302
Mailing Address - Fax:
Practice Address - Street 1:140 VASHTI DR
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-6294
Practice Address - Country:US
Practice Address - Phone:252-725-1302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC00037541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical