Provider Demographics
NPI:1881138295
Name:LOPEZ, ALISA G (LCSW)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:G
Last Name:LOPEZ
Suffix:
Gender:
Credentials:LCSW
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 3015
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93438-3015
Mailing Address - Country:US
Mailing Address - Phone:805-995-9393
Mailing Address - Fax:
Practice Address - Street 1:515 E OCEAN AVE STE E
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6926
Practice Address - Country:US
Practice Address - Phone:805-995-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW60476101YM0800X
CA994021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health