Provider Demographics
NPI:1093330870
Name:LOPEZ, SAMANTHA ALICE (LMFT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ALICE
Last Name:LOPEZ
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N CUYAMACA ST STE 107
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1865
Mailing Address - Country:US
Mailing Address - Phone:619-405-2476
Mailing Address - Fax:619-566-3578
Practice Address - Street 1:900 N CUYAMACA ST STE 107
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-1865
Practice Address - Country:US
Practice Address - Phone:619-405-2476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119364106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist