Provider Demographics
NPI:1578161725
Name:LOPEZ, JOSE SANTOS (LLMSW)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:SANTOS
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7730 SMALE ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-3501
Mailing Address - Country:US
Mailing Address - Phone:586-604-1339
Mailing Address - Fax:586-731-0698
Practice Address - Street 1:7730 SMALE ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48094-3501
Practice Address - Country:US
Practice Address - Phone:586-604-1339
Practice Address - Fax:586-731-0698
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-10
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011021581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical