Provider Demographics
NPI:1336372036
Name:ARCHIBEQUE, ANITA LAVERNE (MA)
Entity type:Individual
Prefix:MS
First Name:ANITA
Middle Name:LAVERNE
Last Name:ARCHIBEQUE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W TOPEKA AVE
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2150
Mailing Address - Country:US
Mailing Address - Phone:719-846-3235
Mailing Address - Fax:
Practice Address - Street 1:108 W TOPEKA AVE
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2150
Practice Address - Country:US
Practice Address - Phone:719-846-3235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health