Provider Demographics
NPI:1598210494
Name:ARCHIBALD, TIERNEN CARTER (LCSW)
Entity Type:Individual
Prefix:
First Name:TIERNEN
Middle Name:CARTER
Last Name:ARCHIBALD
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 1:1355 S COLORADO BLVD STE C-100
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-3305
Mailing Address - Country:US
Mailing Address - Phone:303-756-9052
Mailing Address - Fax:
Practice Address - Street 1:1355 S COLORADO BLVD STE C-100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3305
Practice Address - Country:US
Practice Address - Phone:303-756-9052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-20
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099260611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical