Provider Demographics
NPI:1609987411
Name:AQUINO, ARCHIMEDES MARCELO (LPC)
Entity Type:Individual
Prefix:MR
First Name:ARCHIMEDES
Middle Name:MARCELO
Last Name:AQUINO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:ARCHIE
Other - Middle Name:MARCELO
Other - Last Name:AQUINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:1015 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-6425
Mailing Address - Country:US
Mailing Address - Phone:480-967-1235
Mailing Address - Fax:
Practice Address - Street 1:1415 N TREKELL RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-2832
Practice Address - Country:US
Practice Address - Phone:480-262-7722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-12326101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional