Provider Demographics
NPI:1952677783
Name:LOPEZ, ALLISSA DIANE (MA, LPCC 5695)
Entity Type:Individual
Prefix:MS
First Name:ALLISSA
Middle Name:DIANE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MA, LPCC 5695
Other - Prefix:
Other - First Name:ALLISSA
Other - Middle Name:DIANE
Other - Last Name:PEDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPCC 5695
Mailing Address - Street 1:820 34TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2283
Mailing Address - Country:US
Mailing Address - Phone:661-203-7067
Mailing Address - Fax:661-861-0339
Practice Address - Street 1:820 34TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2283
Practice Address - Country:US
Practice Address - Phone:661-203-7067
Practice Address - Fax:661-861-0339
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPCCI 7101YA0400X, 101YM0800X
CA5695101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health