Provider Demographics
NPI:1689794299
Name:LOPEZ, DOROTHY A (LPC)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:A
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 823
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-0823
Mailing Address - Country:US
Mailing Address - Phone:419-491-0420
Mailing Address - Fax:567-698-7875
Practice Address - Street 1:1910 INDIAN WOOD CIR STE 100
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-4029
Practice Address - Country:US
Practice Address - Phone:419-491-0420
Practice Address - Fax:567-698-7875
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC 0006291101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1437626587OtherANCHORED IN HOPE COUNSELING GROUP NPI