Provider Demographics
NPI:1316283849
Name:LOPEZ PSYCHOLOGICAL SERVICES, PLLC
Entity type:Organization
Organization Name:LOPEZ PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERDZIK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:910-502-0467
Mailing Address - Street 1:PO BOX 87036
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-7036
Mailing Address - Country:US
Mailing Address - Phone:910-502-0467
Mailing Address - Fax:866-707-8680
Practice Address - Street 1:501 EXECUTIVE PL
Practice Address - Street 2:SUITE B
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5390
Practice Address - Country:US
Practice Address - Phone:910-502-0467
Practice Address - Fax:866-707-8680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-03
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4176103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty