Healthcare Provider Details

I. General information

NPI: 1841827797
Provider Name (Legal Business Name): KARINA LOPEZ AICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5411 E MILL PLAIN BLVD STE 28
VANCOUVER WA
98661-7046
US

IV. Provider business mailing address

31405 18TH AVE S
FEDERAL WAY WA
98003-5433
US

V. Phone/Fax

Practice location:
  • Phone: 360-397-4366
  • Fax:
Mailing address:
  • Phone: 253-681-6601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: