Provider Demographics
NPI:1275999351
Name:ARCHIE, MARKEL
Entity Type:Individual
Prefix:
First Name:MARKEL
Middle Name:
Last Name:ARCHIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 BON AIR RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1702
Mailing Address - Country:US
Mailing Address - Phone:415-473-6190
Mailing Address - Fax:415-473-4190
Practice Address - Street 1:250 BON AIR RD
Practice Address - Street 2:SUITE B
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1702
Practice Address - Country:US
Practice Address - Phone:415-473-6190
Practice Address - Fax:415-473-4190
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor