Provider Demographics
NPI:1669275822
Name:ARCHIE, ERICA JEAN (AMFT)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:JEAN
Last Name:ARCHIE
Suffix:
Gender:
Credentials:AMFT
Other - Prefix:MS
Other - First Name:RICKI
Other - Middle Name:JEAN
Other - Last Name:ARCHIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 480557
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1557
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:881 ALMA REAL DR STE 311
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-5047
Practice Address - Country:US
Practice Address - Phone:949-836-8643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA148647106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist