Provider Demographics
NPI:1316819741
Name:LOPEZ MENDEZ, KORALYS M
Entity type:Individual
Prefix:
First Name:KORALYS
Middle Name:M
Last Name:LOPEZ MENDEZ
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 1:3805 BISSETT WAY
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-9814
Mailing Address - Country:US
Mailing Address - Phone:787-515-6134
Mailing Address - Fax:
Practice Address - Street 1:1224 WILLOWLAKE CT
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4421
Practice Address - Country:US
Practice Address - Phone:336-685-1193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0219521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical