Provider Demographics
NPI:1700903341
Name:CURTIS, ERICA KOLUPAILO MAXION (ATR-BC, MFT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:KOLUPAILO MAXION
Last Name:CURTIS
Suffix:
Gender:F
Credentials:ATR-BC, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 BERKELEY ST APT 5
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2519
Mailing Address - Country:US
Mailing Address - Phone:310-482-1273
Mailing Address - Fax:
Practice Address - Street 1:2656 29TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-2902
Practice Address - Country:US
Practice Address - Phone:424-248-8627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2011-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42757106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist