Provider Demographics
NPI:1063623742
Name:ARCHULETA, MARIE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:ARCHULETA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-4138
Mailing Address - Country:US
Mailing Address - Phone:510-759-5555
Mailing Address - Fax:
Practice Address - Street 1:820 23RD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-1338
Practice Address - Country:US
Practice Address - Phone:510-229-5000
Practice Address - Fax:510-235-3112
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)