Individual
DR. SANDRA I LOPEZ-BAEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
405 EMMET ST S, ROOM 150, CHARLOTTESVILLE, VA 22903-2424
(434) 924-7034
Mailing address
405 EMMET ST S, ROOM 150, CHARLOTTESVILLE, VA 22903-2424
(434) 924-7034
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
0701003380
VA
103TC0700X
Clinical Psychologist
Primary
0810004096
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12093636
CAQH
VA
Enumeration date
07/09/2006
Last updated
05/21/2010
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