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General NPI Number Information
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NPI Number | 1386026649
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Entity Type | Individual
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Provider Name | ERICA ANN LOPEZ LMSW
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Gender | Female
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Dates
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Enumeration Date | 06/23/2015
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Last Update Date | 06/23/2015
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Provider Practice Location Address
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Address Line | 9336 W CHAD ST
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City | BOISE
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State | ID
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Zip | 83709-0558
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Country | US
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Telephone | 208-724-9483
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Fax |
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Provider Business Mailing Address
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Address Line | 9336 W CHAD ST
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City | BOISE
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State | ID
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Zip | 83709-0558
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LMSW-33045
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LMSW- 33045
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License Number State | ID
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