Individual
MS. MICHELE LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CASAC
Contact information
Practice address
1519 NYE RD, LYONS, NY 14489-9133
(315) 946-5722
Mailing address
10464 SLAGHT RD, WOLCOTT, NY 14590-9341
(315) 882-0450
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
33295
NY
Other
Enumeration date
12/16/2020
Last updated
12/16/2020
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