Provider Demographics
NPI:1700258175
Name:ARCHER, TONIKA MICHELLE (AMFT)
Entity Type:Individual
Prefix:MISS
First Name:TONIKA
Middle Name:MICHELLE
Last Name:ARCHER
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:
Other - Last Name:ARCHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AMFT
Mailing Address - Street 1:10350 S CALHOUN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617
Mailing Address - Country:US
Mailing Address - Phone:312-428-8085
Mailing Address - Fax:708-487-9955
Practice Address - Street 1:10343 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2410
Practice Address - Country:US
Practice Address - Phone:312-788-0305
Practice Address - Fax:708-974-3845
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000460106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist