Healthcare Provider Details

I. General information

NPI: 1154151793
Provider Name (Legal Business Name): SOPHIA MARIE EFFA M.A., AMFT
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: FIA EFFA M.A., AMFT

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 G ST STE 4
ARCATA CA
95521-6247
US

IV. Provider business mailing address

PO BOX 117
ARCATA CA
95518-0117
US

V. Phone/Fax

Practice location:
  • Phone: 707-502-2083
  • Fax: 707-388-1896
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAMFT147492
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: