Healthcare Provider Details

I. General information

NPI: 1932107968
Provider Name (Legal Business Name): ANN B LOPER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 EMMET STREET, SOUTH
CHARLOTTESVILLE VA
22904-4270
US

IV. Provider business mailing address

417 EMMET STREET, SOUTH P.O. BOX 400270
CHARLOTTESVILLE VA
22904-4270
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-7034
  • Fax: 434-924-4621
Mailing address:
  • Phone: 434-924-7034
  • Fax: 434-924-4621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810001074
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: