Individual
CARLOS G LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1415 LUMSDEN RD, PORT ORCHARD, WA 98367-9179
(360) 881-7878
(360) 876-0713
Mailing address
1415 LUMSDEN RD, PORT ORCHARD, WA 98367-9179
(360) 881-7878
(360) 876-0713
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO60613823
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CO60613823
WASHINGTON STATE DEPARTMENT OF HEALTH
WA
Enumeration date
11/09/2018
Last updated
11/09/2018
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