Individual
CHARITY R LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW,LCSW, CSAC, CSIT
Contact information
Practice address
30401 MOUNTAIN LN, WATERFORD, WI 53185-3442
(262) 455-4018
Mailing address
30401 MOUNTAIN LN, WATERFORD, WI 53185-3442
(765) 618-7021
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
17092132
WI
1041C0700X
Clinical Social Worker
Primary
11160123
WI
Other
Enumeration date
05/01/2024
Last updated
05/01/2024
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