| Angel Lopez Clinic, Inc. | |
|
2250 Satellite Blvd Suite 175 Duluth GA 30097 | |
| (770) 232-0555 | |
| (770) 232-0640 |
| Full Name | Angel Lopez Clinic, Inc. |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 2250 Satellite Blvd, Duluth, Georgia |
| Authorized Official Name and Position | Sara Boucchechter (OWNER/PRESIDENT) |
| Authorized Official Contact | 7702320555 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Angel Lopez Clinic, Inc. 2250 Satellite Blvd Suite 175 Duluth GA 30097 Ph: (770) 232-0555 | Angel Lopez Clinic, Inc. 2250 Satellite Blvd Suite 175 Duluth GA 30097 Ph: (770) 232-0555 |
| NPI Number | 1972777654 |
|---|---|
| Provider Enumeration Date | 04/14/2008 |
| Last Update Date | 02/19/2021 |
| Certification Date | 02/19/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972777654 | NPI | - | NPPES |
| 018244591B | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
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