Provider Demographics
NPI:1659498632
Name:ARCHIE, DOROTHY OBEDIA
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:OBEDIA
Last Name:ARCHIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:OBEDIA
Other - Last Name:SHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:129 GALES RIVER RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2458
Mailing Address - Country:US
Mailing Address - Phone:803-781-2169
Mailing Address - Fax:
Practice Address - Street 1:1800 COLONIAL DR
Practice Address - Street 2:CONNECTIONS
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6827
Practice Address - Country:US
Practice Address - Phone:803-898-1555
Practice Address - Fax:803-898-2194
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health