Provider Demographics
NPI:1558181438
Name:LOPEZ, RENEE LORRAINE (PHD)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:LORRAINE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:958 MIDDLE FORK TRL
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1709
Mailing Address - Country:US
Mailing Address - Phone:303-748-1464
Mailing Address - Fax:
Practice Address - Street 1:4411 SUWANEE DAM RD STE 545
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8708
Practice Address - Country:US
Practice Address - Phone:404-981-5084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY004647103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling