Provider Demographics
NPI:1053190629
Name:ARCHER, SHIRLENCE LEKIA
Entity type:Individual
Prefix:
First Name:SHIRLENCE
Middle Name:LEKIA
Last Name:ARCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 MONTEBELLO LN
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-3853
Mailing Address - Country:US
Mailing Address - Phone:678-408-1329
Mailing Address - Fax:
Practice Address - Street 1:68 MONTEBELLO LN
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-3853
Practice Address - Country:US
Practice Address - Phone:678-408-1329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013151101YM0800X
SC9128101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health