Individual
SAMANTHA-JANE LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6810 OLD 28TH ST SE STE 4, GRAND RAPIDS, MI 49546-6932
(616) 516-3396
Mailing address
959 HOUSEMAN AVE NE, GRAND RAPIDS, MI 49503-1280
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
MI
Other
Enumeration date
03/09/2022
Last updated
03/09/2022
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