Provider Demographics
NPI:1568819175
Name:LOPEZ, KRISTY ANN (PCCI; LPC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:ANN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PCCI; LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21455 BIRCH ST
Mailing Address - Street 2:201
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-2165
Mailing Address - Country:US
Mailing Address - Phone:510-844-5370
Mailing Address - Fax:510-583-0410
Practice Address - Street 1:21455 BIRCH ST
Practice Address - Street 2:201
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-2165
Practice Address - Country:US
Practice Address - Phone:510-844-5370
Practice Address - Fax:510-583-0410
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPCCI3648101YM0800X
LA5885101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health