Provider Demographics
NPI:1164858932
Name:ARCHER, GEORGIA T (LSW)
Entity Type:Individual
Prefix:MS
First Name:GEORGIA
Middle Name:T
Last Name:ARCHER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:ANALOMINK
Mailing Address - State:PA
Mailing Address - Zip Code:18320-0072
Mailing Address - Country:US
Mailing Address - Phone:570-369-4732
Mailing Address - Fax:
Practice Address - Street 1:633 LAKESIDE DRIVE
Practice Address - Street 2:
Practice Address - City:TOBYHANNA
Practice Address - State:PA
Practice Address - Zip Code:18466
Practice Address - Country:US
Practice Address - Phone:866-343-5509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW130298104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker