Provider Demographics
NPI:1326246406
Name:LOPEZ, GLORIA
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-4303
Mailing Address - Country:US
Mailing Address - Phone:805-922-2243
Mailing Address - Fax:
Practice Address - Street 1:1523 LONGBRANCH AVE
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-2508
Practice Address - Country:US
Practice Address - Phone:805-473-7004
Practice Address - Fax:805-473-7188
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI38070423101YA0400X
CAASW120341104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)