Healthcare Provider Details

I. General information

NPI: 1922939800
Provider Name (Legal Business Name): MATTHEW CHARLES LOPRIENO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 SUWANEE DAM RD
SUWANEE GA
30024-8701
US

IV. Provider business mailing address

4411 SUWANEE DAM RD
SUWANEE GA
30024-8701
US

V. Phone/Fax

Practice location:
  • Phone: 678-993-8494
  • Fax:
Mailing address:
  • Phone: 678-993-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: