Provider Demographics
NPI:1154943090
Name:LOPER, JOANNA EVELYN (BS)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:EVELYN
Last Name:LOPER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 W MARKET ST STE 110
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-2344
Mailing Address - Country:US
Mailing Address - Phone:302-752-1783
Mailing Address - Fax:
Practice Address - Street 1:505 W MARKET ST STE 110
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-2344
Practice Address - Country:US
Practice Address - Phone:302-752-1783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health