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General NPI Number Information
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NPI Number | 1770079196
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Entity Type | Individual
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Provider Name | NATHALIA LOPEZ MA, LAC, NCC
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Gender | Female
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Dates
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Enumeration Date | 07/09/2018
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 1 VANDERVEER DR
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-3113
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Country | US
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Telephone | 609-647-0714
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Fax |
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Provider Business Mailing Address
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Address Line | 901 FOX GLEN CT
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City | BARRINGTON
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State | IL
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Zip | 60010-1863
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Country | US
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Telephone | 847-304-0780
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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