Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | CW022006 | PA |
NPI | 1003123803 |
---|---|
Provider Name | Melissa Lopez |
First Address | Wyomissing, PA 19610-1341 |
Second Address | Wyomissing, PA 19610-1341 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2010 |
Last Update Date | 09/12/2021 |