Provider Demographics
NPI:1205970506
Name:HUMPHREYS, ALISON (LCPC)
Entity type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:
Last Name:HUMPHREYS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 DILLON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4941
Mailing Address - Country:US
Mailing Address - Phone:443-995-0719
Mailing Address - Fax:410-563-1688
Practice Address - Street 1:4940 EASTERN AVE
Practice Address - Street 2:MASON F. LORD BUILDING, D2 EAST
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2735
Practice Address - Country:US
Practice Address - Phone:443-995-0719
Practice Address - Fax:410-563-1688
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2206101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health