Basic Information
| Provider Information | |||||||||
| NPI: | 1811619661 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARCHE | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | JORDAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10591 OAK LN APT 17207 | ||||||||
| Address2: | |||||||||
| City: | VAN BUREN TWP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481114763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867033191 | ||||||||
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| Practice Location | |||||||||
| Address1: | 707 W MILWAUKEE ST | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482022943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138332500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2022 | ||||||||
| LastUpdateDate: | 09/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.