Individual
THERESA HUMPHREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17 DELSEA DR S, GLASSBORO, NJ 08028-2620
(856) 964-1990
Mailing address
584 BENSON ST, CAMDEN, NJ 08103-1324
(856) 964-1990
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
37CA00075800
NJ
Other
Enumeration date
08/01/2018
Last updated
08/01/2018
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