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General NPI Number Information
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NPI Number | 1558181438
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Entity Type | Individual
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Provider Name | RENEE LORRAINE LOPEZ PHD
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Gender | Female
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 4411 SUWANEE DAM RD STE 545
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City | SUWANEE
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State | GA
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Zip | 30024-8708
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Country | US
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Telephone | 404-981-5084
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Fax |
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Provider Business Mailing Address
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Address Line | 958 MIDDLE FORK TRL
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City | SUWANEE
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State | GA
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Zip | 30024-1709
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Country | US
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Telephone | 303-748-1464
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PSY004647
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License Number State | GA
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