Provider Demographics
NPI:1750856605
Name:LINDA ARCHIBALD LMSW LLC
Entity Type:Organization
Organization Name:LINDA ARCHIBALD LMSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHIBALD
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:586-242-4245
Mailing Address - Street 1:20328 YALE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1746
Mailing Address - Country:US
Mailing Address - Phone:586-242-4245
Mailing Address - Fax:
Practice Address - Street 1:23915 JEFFERSON AVE STE 5
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1512
Practice Address - Country:US
Practice Address - Phone:586-242-4245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty