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1164021135
IRENE BAUTISTA LOPEZ
LAWRENCEVILLE, GA
NPI
1164021135
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: GA APC007617)
Enumeration Date
2020-10-21
Last Update Date
2020-10-21
Business Address
IRENE BAUTISTA LOPEZ MS, APC, NCC
175 GWINNETT DR
LAWRENCEVILLE, GA 30046-8444
Phone number: 678-209-2394
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Mailing Address
IRENE BAUTISTA LOPEZ MS, APC, NCC
1727 CHASE COMMON CT
NORCROSS, GA 30071-3565
Phone number: 803-944-1359
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