Provider Demographics
NPI:1477989507
Name:LOPEZ, ANGEL (LMHC, NCC, MCAP, QS)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:LMHC, NCC, MCAP, QS
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:MARIE
Other - Last Name:LOPEZ-GRIMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8249 SW 149TH CT APT 204
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-3103
Mailing Address - Country:US
Mailing Address - Phone:786-319-7035
Mailing Address - Fax:
Practice Address - Street 1:14802 SW 183RD TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-1929
Practice Address - Country:US
Practice Address - Phone:786-319-7035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
FLMH13694101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)