Individual
DR. WANDAMARIA B LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
2935 N ASHLEY ST, SUITE F, VALDOSTA, GA 31602-1777
(229) 333-2273
(229) 293-7911
Mailing address
2935 N ASHLEY ST, SUITE F, VALDOSTA, GA 31602-1777
(229) 333-2273
(229) 293-7911
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY001532
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000463724B
—
GA
01
—
281450LO
BCBS
GA
01
—
XXXXX9255
TRICARE
GA
Enumeration date
07/10/2006
Last updated
04/28/2021
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