Provider Demographics
NPI:1447524897
Name:ARCHER, VIRGINIA PARKER (LCSW)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:PARKER
Last Name:ARCHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 N CLARK ST
Mailing Address - Street 2:SUITE 413
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2702
Mailing Address - Country:US
Mailing Address - Phone:312-420-7156
Mailing Address - Fax:
Practice Address - Street 1:1165 N CLARK ST
Practice Address - Street 2:SUITE 413
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-2702
Practice Address - Country:US
Practice Address - Phone:312-420-7156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-009771101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health