Healthcare Provider Details

I. General information

NPI: 1851046551
Provider Name (Legal Business Name): DEBORAH PEREZ-LOPEZ MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 02/21/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4810 WRIGHTSVILLE AVE
WILMINGTON NC
28403-6917
US

IV. Provider business mailing address

341 S. COLLEGE RD. STE 11 PMB 1095
WILMINGTON NC
28403
US

V. Phone/Fax

Practice location:
  • Phone: 347-640-3294
  • Fax:
Mailing address:
  • Phone: 347-640-3294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15267
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC008870
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: