Provider Demographics
NPI:1538580162
Name:LOPEZ, VIRGINIA (MA-CADCIII)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MA-CADCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9370 SW GREENBURG RD STE 601
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5429
Mailing Address - Country:US
Mailing Address - Phone:503-372-5452
Mailing Address - Fax:503-372-5469
Practice Address - Street 1:9370 SW GREENBURG RD STE 601
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5429
Practice Address - Country:US
Practice Address - Phone:503-372-5452
Practice Address - Fax:503-372-5469
Is Sole Proprietor?:No
Enumeration Date:2013-12-27
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00-P-04101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)