Provider Demographics
NPI:1811416696
Name:MCDONALD, ARCHELENA MONIQUE (LCSW)
Entity Type:Individual
Prefix:
First Name:ARCHELENA
Middle Name:MONIQUE
Last Name:MCDONALD
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 1:3855 ALAMO ST STE A
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-2104
Mailing Address - Country:US
Mailing Address - Phone:562-446-3989
Mailing Address - Fax:
Practice Address - Street 1:3855 ALAMO ST STE A
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2104
Practice Address - Country:US
Practice Address - Phone:562-446-3989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98358101YM0800X
CA1151771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health