Individual
STACY LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ADC, MSP
Contact information
Practice address
709 DEARBORN ST, CALDWELL, ID 83605-4116
(208) 376-7083
(208) 402-5604
Mailing address
709 DEARBORN ST, CALDWELL, ID 83605-4116
(208) 376-7083
(208) 402-5604
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11909
ID
Other
Enumeration date
07/08/2024
Last updated
07/08/2024
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