Provider Demographics
NPI:1356025068
Name:ARCHER, MARY ELIZABETH (LMSW)
Entity type:Individual
Prefix:
First Name:MARY ELIZABETH
Middle Name:
Last Name:ARCHER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 WESTBURY CT SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4815
Mailing Address - Country:US
Mailing Address - Phone:512-589-6661
Mailing Address - Fax:
Practice Address - Street 1:2717 N HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-9349
Practice Address - Country:US
Practice Address - Phone:470-244-2574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW011053104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker