Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1073958369 |
---|---|
Provider Name | Dr. Douglas John Archie III |
First Address | Tampa, FL 33610-4350 |
Second Address | Indianapolis, IN 46202-2803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2013 |
Last Update Date | 19/10/2021 |