MEDICARE: MR. GONTRAN S ARCHER JR. M.A., LCPC

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
1	101YP2500X	Professional Counselor	LC13937	MD
2	101YM0800X	Mental Health Counselor	LC13937	MD

General Provider Information

NPI Number	:	1568144400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GONTRAN S ARCHER JR. M.A., LCPC

Provider Business Mailing Address
First Line	:	509 DENNIS MAGRUDER DR
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-2110
Country	:	US
Telephone Number	:	585-305-1464
Fax Number	:

Provider Business Practice Location Address
First Line	:	509 DENNIS MAGRUDER DR
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-2110
Country	:	US
Telephone Number	:	585-305-1465
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2023
Last Update Date	:	04/28/2025

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