Individual
ANNAI LOPEZ TAVIRA CRUZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MFT, LMFT
Contact information
Practice address
6015 ATLANTIC BLVD STE A, NORCROSS, GA 30071-1343
(770) 361-4607
Mailing address
824 WHITEHAVEN LN, LAWRENCEVILLE, GA 30043-6666
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MFT001573
GA
Other
Enumeration date
06/15/2016
Last updated
04/03/2019
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