Wandamaria B Lopez in Valdosta - Clinical
Wandamaria B Lopez - NPI 1124052667
Wandamaria B Lopez is a Clinical in Valdosta, Georgia. Wandamaria B Lopez practices all healthcare services and medical treatments related to Clinical. The NPI Number for Wandamaria B Lopez is 1124052667. The last update date is 2021-04-28.
Wandamaria B Lopez's current location address is 2935 N Ashley St, Valdosta, Georgia. You can contact this provider via phone number 2293332273 and fax number 2292937911. The mailing address for Wandamaria B Lopez is 2935 N Ashley St, Valdosta, Georgia. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Wandamaria B Lopez |
|---|---|
| Address | 2935 N Ashley St, Valdosta, Georgia |
| Phone Number | 2293332273 |
| Fax Number | 2292937911 |
| Sole Proprietor | Y |
| Credentials | PHD |
NPI Number Detail
| NPI Number | 1124052667 |
|---|---|
| Provider Enumeration Date | 2006-07-10 |
| Last Updated Date | 2021-04-28 |
Provider Mailing Address Detail
| Address | 2935 N Ashley St |
|---|---|
| City | Valdosta |
| State | Georgia (GA) |
| Post Code | 316021777 |
| Phone Number | 2293332273 |
| Fax Number | 2292937911 |
Provider's Primary Taxonomy Detail
| Speciality | Clinical |
|---|---|
| Taxonomy | 103Tc0700X |
| Licence No | PSY001532 |
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Definition: A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| XXXXX9255 | GA | TRICARE | |
| 281450LO | GA | BCBS | |
| 000463724B | GA | -- |
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What is the unique 10-digit identifier code issued to Wandamaria B Lopez by the Centers for Medicare & Medicaid Services?
The Wandamaria B Lopez has been assigned the NPI (National Provider Identifier) 1124052667 by the CMS (Centers for Medicare & Medicaid Services). This 10-digit code serves as a unique identification number for healthcare providers.
Could you share the physical location details of Wandamaria B Lopez?
The Wandamaria B Lopez is situated at 2935 N Ashley St, in the city of Valdosta, state of GA, with the zip code 316021777.
What is the Wandamaria B Lopez's area of specialization and corresponding taxonomy classification?
The Wandamaria B Lopez's specialty field is Clinical, and it falls under the taxonomy code 103Tc0700X, which categorizes healthcare providers based on their specialties.
On what date did the Centers for Medicare & Medicaid Services originally issue the 1124052667 to Wandamaria B Lopez?
The Centers for Medicare & Medicaid Services originally issued the 1124052667 to Wandamaria B Lopez on 2006-07-10.
When was the information related to Wandamaria B Lopez most recently updated or refreshed?
The details pertaining to the Wandamaria B Lopez, including its address, specialty, and other relevant information, were last updated or refreshed on 2021-04-28.