Provider Demographics
NPI:1154196392
Name:AGBABIAN, ERIKA (MA, AMFT)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:AGBABIAN
Suffix:
Gender:F
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 REES ST
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-7661
Mailing Address - Country:US
Mailing Address - Phone:310-405-9038
Mailing Address - Fax:
Practice Address - Street 1:3756 SANTA ROSALIA DR STE 628
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3606
Practice Address - Country:US
Practice Address - Phone:310-645-5227
Practice Address - Fax:310-645-9840
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA141312106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist