Provider Demographics
NPI:1548365356
Name:ARCHBOLD, MARJORIE A (MA LCPC)
Entity type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:A
Last Name:ARCHBOLD
Suffix:
Gender:F
Credentials:MA LCPC
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:
Other - Last Name:RANDOLPH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:552 S WASHINGTON ST
Mailing Address - Street 2:SUITE 119
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6658
Mailing Address - Country:US
Mailing Address - Phone:630-640-3108
Mailing Address - Fax:
Practice Address - Street 1:552 S WASHINGTON ST
Practice Address - Street 2:SUITE 119
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6658
Practice Address - Country:US
Practice Address - Phone:630-640-3108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180001692101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional