Provider Demographics
NPI:1053877191
Name:THOMAS-LOPEZ, EMMA (DSW)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:THOMAS-LOPEZ
Suffix:
Gender:F
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 ALBANY ST
Mailing Address - Street 2:
Mailing Address - City:MORVEN
Mailing Address - State:GA
Mailing Address - Zip Code:31638-2339
Mailing Address - Country:US
Mailing Address - Phone:229-292-4361
Mailing Address - Fax:
Practice Address - Street 1:118 ALBANY ST
Practice Address - Street 2:
Practice Address - City:MORVEN
Practice Address - State:GA
Practice Address - Zip Code:31638-2339
Practice Address - Country:US
Practice Address - Phone:229-292-4361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor