Individual
JENNIFER E HUMPHREYS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, MED, BCBA
Contact information
Practice address
4929 DARCY WOODS LN, FUQUAY VARINA, NC 27526-7622
(408) 540-4551
Mailing address
510 RIDGECREST RD, CARY, NC 27511-3119
(408) 540-4551
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-18-31808
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/09/2018
Last updated
10/27/2020
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