Provider Demographics
NPI:1235927955
Name:ALISA LOPEZ, A LICENSED CLINICAL SOCIAL WORKER GROUP INC
Entity type:Organization
Organization Name:ALISA LOPEZ, A LICENSED CLINICAL SOCIAL WORKER GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:805-995-9393
Mailing Address - Street 1:PO BOX 3015
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93438-3015
Mailing Address - Country:US
Mailing Address - Phone:805-995-9393
Mailing Address - Fax:
Practice Address - Street 1:515 E OCEAN AVE STE E
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6926
Practice Address - Country:US
Practice Address - Phone:805-995-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty