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General NPI Number Information
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NPI Number | 1649656315
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Entity Type | Individual
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Provider Name | CARLOS LOPEZ
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Gender | Male
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Dates
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Enumeration Date | 08/05/2015
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 101 DONALD ROSS DR
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City | RALEIGH
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State | NC
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Zip | 27610-2593
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Country | US
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Telephone | 919-250-3320
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Fax |
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Provider Business Mailing Address
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Address Line | 200 E MAIN ST SUITE 201
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City | CLAYTON
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State | NC
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Zip | 27520-2472
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | A12129
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCAS-22117
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License Number State | NC
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