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NPI Code Detail

MEDICARE: MR. REGINALD ARCHIE LCDC

MEDICARE: MR. REGINALD ARCHIE LCDC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor11644TX

General Provider Information

NPI Number : 1427474154
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. REGINALD ARCHIE LCDC
Provider Business Mailing Address
First Line : 1213 DURHAM DR
Second Line :
City : HOUSTON
State : TX
Zip : 77007-5409
Country : US
Telephone Number : 713-636-9138
Fax Number : 281-888-6510
Provider Business Practice Location Address
First Line : 1213 DURHAM DR
Second Line :
City : HOUSTON
State : TX
Zip : 77007-5409
Country : US
Telephone Number : 713-636-9138
Fax Number : 281-888-6510
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2014
Last Update Date : 04/03/2014

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