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Individual

JAMIE LEIGH HASELEY LOPEZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PHD HSPP

Contact information

Practice address
1528 SMOKY PARK HWY, CANDLER, NC 28715-9341
(415) 572-6450
(408) 890-4632
Mailing address
1528 SMOKY PARK HWY, CANDLER, NC 28715-9341
(415) 572-6450
(408) 890-4632

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
20042197A
IN
103T00000X
Psychologist
Primary
4338
NC
103TC2200X
Clinical Child & Adolescent Psychologist
20042197
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200903840
IN
Enumeration date
08/21/2007
Last updated
11/28/2012
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