Provider Demographics
NPI:1548622574
Name:JAMIE L. HASELEY LOPEZ
Entity type:Organization
Organization Name:JAMIE L. HASELEY LOPEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:HASELEY LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:415-572-6450
Mailing Address - Street 1:116 HARROP DUN CT
Mailing Address - Street 2:
Mailing Address - City:BILTMORE LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28715-7901
Mailing Address - Country:US
Mailing Address - Phone:415-572-6450
Mailing Address - Fax:
Practice Address - Street 1:30 GARFIELD ST STE A
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-7301
Practice Address - Country:US
Practice Address - Phone:828-761-1017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4338103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6001390Medicaid