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General NPI Number Information
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NPI Number | 1780117408
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Entity Type | Organization
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Legal Business Name | CARLOS L. LOPEZ
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 04/10/2017
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Provider Practice Location Address
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Address Line | 880 MAIN ST
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City | LINCOLN
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State | ME
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Zip | 04457-4601
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Country | US
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Telephone | 207-403-9215
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Fax |
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Provider Business Mailing Address
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Address Line | 880 MAIN ST
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City | LINCOLN
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State | ME
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Zip | 04457-4601
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Country | US
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Telephone | 207-403-9215
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARLOS L LOPEZ
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Credential |
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Telephone | 207-403-9295
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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 |
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License Number State |
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