Individual
CRISTA LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
10379B DEMOCRACY LN, FAIRFAX, VA 22030-2505
(703) 591-2551
Mailing address
25099 CROXLEY GREEN SQ, ALDIE, VA 20105-5672
(571) 225-9563
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
0704013702
VA
Other
Enumeration date
03/15/2021
Last updated
12/03/2021
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