Individual
OTHONIEL LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
250 GEORGIA AVE E UNIT 143122, FAYETTEVILLE, GA 30214-5533
(470) 696-5526
Mailing address
250 GEORGIA AVE E UNIT 143122, FAYETTEVILLE, GA 30214-5533
(470) 696-5526
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
133693
CA
1041C0700X
Clinical Social Worker
Primary
CSW006681
GA
1041C0700X
Clinical Social Worker
TPSW3568
FL
Other
Enumeration date
02/01/2011
Last updated
03/18/2026
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