Organization
A VICTORS GATHERING COUNSELING SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTINE ANNETTE LOPEZ LCSW (THERAPIST/OWNER)
(208) 596-4129
Entity
Organization
Contact information
Practice address
417 E VEATCH ST, MOSCOW, ID 83843-3570
(208) 874-7989
Mailing address
417 E VEATCH ST, MOSCOW, ID 83843-3570
(208) 874-7989
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
01/15/2020
Last updated
12/13/2023
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