Provider Demographics
NPI:1093537516
Name:HUMPHREY, ADRINA DENISE (LCSW)
Entity type:Individual
Prefix:
First Name:ADRINA
Middle Name:DENISE
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 OARLOCK DR
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-6412
Mailing Address - Country:US
Mailing Address - Phone:817-405-9295
Mailing Address - Fax:
Practice Address - Street 1:1004 OARLOCK DR
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-6412
Practice Address - Country:US
Practice Address - Phone:817-443-1467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX658091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical