Organization
ANGEL LOPEZ CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SARA BOUCCHECHTER (OWNER/PRESIDENT)
(770) 232-0555
Entity
Organization
Contact information
Practice address
2250 SATELLITE BLVD, SUITE 175, DULUTH, GA 30097
(770) 232-0555
(770) 232-0640
Mailing address
2250 SATELLITE BLVD, SUITE 175, DULUTH, GA 30097
(770) 232-0555
(770) 232-0640
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018244591B
—
GA
Enumeration date
04/14/2008
Last updated
02/19/2021
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