Provider Demographics
NPI:1659517381
Name:LOPEZ, ALEXANDER (MS, LPA, HSP-PA)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MS, LPA, HSP-PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 COURT DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-1478
Mailing Address - Country:US
Mailing Address - Phone:704-824-4999
Mailing Address - Fax:704-824-3999
Practice Address - Street 1:16409 NORTHCROSS DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5065
Practice Address - Country:US
Practice Address - Phone:980-441-8200
Practice Address - Fax:980-441-8202
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-31
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3556103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107624Medicaid