Provider Demographics
NPI:1518041037
Name:ARCHWAY ENTERPRISES, INC.
Entity Type:Organization
Organization Name:ARCHWAY ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINSON-SAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, NCC, CAP
Authorized Official - Phone:321-953-3225
Mailing Address - Street 1:325 ANGELO LN
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-3601
Mailing Address - Country:US
Mailing Address - Phone:321-953-3225
Mailing Address - Fax:321-953-3252
Practice Address - Street 1:1503 PINE ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3120
Practice Address - Country:US
Practice Address - Phone:321-953-3225
Practice Address - Fax:321-953-3252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0005906101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCAQH #11566536OtherPROVIDER INSURANCE #