Provider Demographics
NPI:1104582337
Name:LOPEZ, CAMIKA LACHAE
Entity type:Individual
Prefix:
First Name:CAMIKA
Middle Name:LACHAE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1122 WAIPUHIA ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6490
Mailing Address - Country:US
Mailing Address - Phone:808-372-3786
Mailing Address - Fax:
Practice Address - Street 1:91-1122 WAIPUHIA ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-6490
Practice Address - Country:US
Practice Address - Phone:808-372-3786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4517104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker