Provider Demographics
NPI:1760143002
Name:HUMPHREY, PAULA LYNN (LICSW)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:LYNN
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 HARPER ST
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-3317
Mailing Address - Country:US
Mailing Address - Phone:304-640-3620
Mailing Address - Fax:
Practice Address - Street 1:201 JONES AVE
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-2973
Practice Address - Country:US
Practice Address - Phone:304-465-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-09
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP0009413841041C0700X
IA1190031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical