Provider Demographics
NPI:1558595488
Name:ARCHER, ARLENE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ARLENE
Middle Name:
Last Name:ARCHER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3848 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-9642
Mailing Address - Country:US
Mailing Address - Phone:269-240-3085
Mailing Address - Fax:269-683-0449
Practice Address - Street 1:205 BROADWAY ST
Practice Address - Street 2:SUITE A
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2778
Practice Address - Country:US
Practice Address - Phone:269-683-8972
Practice Address - Fax:269-683-0449
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6301014106103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist