Provider Demographics
NPI:1538671839
Name:HUMPHRIES, REGENA M (LICSW, LCSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:REGENA
Middle Name:M
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:LICSW, LCSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14011 WHEEL WRIGHT PL
Mailing Address - Street 2:
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607-3794
Mailing Address - Country:US
Mailing Address - Phone:202-487-9264
Mailing Address - Fax:
Practice Address - Street 1:1727 KING ST STE 105
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2700
Practice Address - Country:US
Practice Address - Phone:703-831-7872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD139501041C0700X
DCLC500797771041C0700X
VA09040101691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical