Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 4556 | NY |
NPI | 1003439001 |
---|---|
Provider Name | Katrina Lopez |
First Address | Glenville, NY 12302-4523 |
Second Address | Plattsburgh, NY 12901-4700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2020 |
Last Update Date | 26/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01420800 | (05) | NY |