Individual
ELISE LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
105 GRAND CENTRAL BLVD STE 10, POOLER, GA 31322-4148
(912) 244-3305
Mailing address
105 GRAND CENTRAL BLVD STE 10, POOLER, GA 31322-4148
(912) 244-3305
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/14/2022
Last updated
03/12/2026
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