Healthcare Provider Details

I. General information

NPI: 1265766208
Provider Name (Legal Business Name): SUSAN ARCHER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4908 DOMINION BLVD STE F
GLEN ALLEN VA
23060-6774
US

IV. Provider business mailing address

6301 BANSHIRE DR
MECHANICSVILLE VA
23111-6572
US

V. Phone/Fax

Practice location:
  • Phone: 804-928-1788
  • Fax: 804-533-4233
Mailing address:
  • Phone: 804-928-1788
  • Fax: 804-533-4233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904005184
License Number StateVA

VIII. Authorized Official

Name: SUSAN MARGARET ARCHER
Title or Position: ONWER
Credential: LCSW
Phone: 804-928-1788