Provider Demographics
NPI:1861708562
Name:ARCHER, VIRGINIA BRADSHAW (LPC)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:BRADSHAW
Last Name:ARCHER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:GINNY
Other - Middle Name:
Other - Last Name:ARCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:226 AUBURN DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-3403
Mailing Address - Country:US
Mailing Address - Phone:256-487-2115
Mailing Address - Fax:
Practice Address - Street 1:216 MADISON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-2528
Practice Address - Country:US
Practice Address - Phone:256-487-2115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1205101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional