Individual
MARK S PEREZ-LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH D LCP
Contact information
Practice address
200 PROFESSIONAL PARK DR SE, SUITE 4, BLACKSBURG, VA 24060-6679
(540) 951-4800
(540) 951-3081
Mailing address
200 PROFESSIONAL PARK DR SE, SUITE 4, BLACKSBURG, VA 24060-6679
(540) 951-4800
(540) 951-3081
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
0810003586
VA
Other
Enumeration date
07/21/2006
Last updated
07/08/2007
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