Healthcare Provider Details

I. General information

NPI: 1578156899
Provider Name (Legal Business Name): MARISA YOLANDA LOPEZ M.A, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 06/27/2025
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44444 20TH ST W
LANCASTER CA
93534-2714
US

IV. Provider business mailing address

44444 20TH ST W
LANCASTER CA
93534-2714
US

V. Phone/Fax

Practice location:
  • Phone: 661-951-0070
  • Fax:
Mailing address:
  • Phone: 661-951-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC17241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: