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General NPI Number Information
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NPI Number | 1306109343
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Entity Type | Organization
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Legal Business Name | ARCHIBALD OPTIMAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 06/22/2012
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 1431 E BALTIMORE ST
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City | BALTIMORE
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State | MD
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Zip | 21231-1405
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Country | US
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Telephone | 410-258-1872
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Fax |
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Provider Business Mailing Address
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Address Line | 1431 E BALTIMORE ST
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City | BALTIMORE
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State | MD
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Zip | 21231-1405
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Country | US
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Telephone | 410-357-1404
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Fax | 410-342-4130
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Authorized Official
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Title or Position | CEO
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Name | DR. PAUL ARCHIBALD
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Credential | LCSW-C
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Telephone | 410-357-1404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC2342
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11283
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License Number State | MD
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