Provider Demographics
NPI:1023443603
Name:LOPEZ, VICTORIA (LMHCA, LMP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LMHCA, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 E OLIVE ST
Mailing Address - Street 2:#310
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2757
Mailing Address - Country:US
Mailing Address - Phone:206-261-6535
Mailing Address - Fax:
Practice Address - Street 1:1605 E OLIVE ST UNIT 310
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2715
Practice Address - Country:US
Practice Address - Phone:206-261-6535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-13
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017259225700000X
WALH60543782101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist