Provider Demographics
NPI:1538785357
Name:LOPEZ, MARIA ANGELICA (CERTIFIED COUNSELOR)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:ANGELICA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:CERTIFIED COUNSELOR
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:ANGELICA
Other - Last Name:LOPEZ DE AERAUDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22815 LAKEVIEW DR APT 'G' - 308
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043
Mailing Address - Country:US
Mailing Address - Phone:425-480-9869
Mailing Address - Fax:
Practice Address - Street 1:22815 LAKEVIEW DR APT 'G' - 308
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043
Practice Address - Country:US
Practice Address - Phone:425-480-9869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60989669101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor