Provider Demographics
NPI:1104241793
Name:ARCHER, PATRICIA A (MS, CACIII)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:ARCHER
Suffix:
Gender:F
Credentials:MS, CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9023 W CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-2926
Mailing Address - Country:US
Mailing Address - Phone:720-633-6679
Mailing Address - Fax:
Practice Address - Street 1:7853 E ARAPAHOE CT
Practice Address - Street 2:3550
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1359
Practice Address - Country:US
Practice Address - Phone:888-516-5995
Practice Address - Fax:303-600-6629
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4524101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)