Healthcare Provider Details

I. General information

NPI: 1871251579
Provider Name (Legal Business Name): PATTI ARCHER GOLDEN LICSW, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATTI JUNE ARCHER MSW, LICSW, LISW

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 DUPONT RD STE 3
PARKERSBURG WV
26101-9704
US

IV. Provider business mailing address

1809 DUPONT RD STE 3
PARKERSBURG WV
26101-9704
US

V. Phone/Fax

Practice location:
  • Phone: 304-861-5184
  • Fax: 304-861-5187
Mailing address:
  • Phone: 304-861-5184
  • Fax: 304-861-5187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00454310
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0009608
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: