Individual
MARISSA LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
750 8TH AVE, FORT WORTH, TX 76104-2515
(682) 885-4157
Mailing address
4804 DORSEY ST, FOREST HILL, TX 76119-7521
(817) 353-3682
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
104751
TX
Other
Enumeration date
07/11/2022
Last updated
07/11/2022
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