Individual
RYQUAISA KYELLA HUMPHREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCASA, LCSWA
Contact information
Practice address
596 E JACKSON BLVD BLDG B, ERWIN, NC 28339-9629
(910) 897-2008
Mailing address
185 BRYSON CT APT 104, LILLINGTON, NC 27546-6372
(704) 953-5595
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
21744
NC
1041C0700X
Clinical Social Worker
P01635
NC
Other
Enumeration date
07/23/2021
Last updated
07/23/2021
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