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General NPI Number Information
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NPI Number | 1164833646
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Entity Type | Individual
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Provider Name | CHARLES ARCHER
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Gender | Male
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Dates
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Enumeration Date | 05/19/2014
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 160 N 4TH ST
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City | ZANESVILLE
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State | OH
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Zip | 43701-3518
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Country | US
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Telephone | 740-454-9751
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Fax | 740-455-4325
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Provider Business Mailing Address
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Address Line | 705 ORCHARD HILL RD
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City | ZANESVILLE
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State | OH
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Zip | 43701-1318
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Country | US
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Telephone | 740-588-5544
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Fax | 740-455-4325
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | UA1015311
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License Number State | OH
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