Individual
JACKIE A LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2708 WESTMOOR CT SW, OLYMPIA, WA 98502-5754
(360) 943-8810
Mailing address
2708 WESTMOOR CT SW, OLYMPIA, WA 98502-5754
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MG60892513
WA
Other
Enumeration date
09/26/2018
Last updated
06/11/2019
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