Healthcare Provider Details

I. General information

NPI: 1396486452
Provider Name (Legal Business Name): OPAL HOLISTIC HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 08/13/2022
Certification Date: 08/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 PEARL ST STE 205
YPSILANTI MI
48197-5374
US

IV. Provider business mailing address

124 PEARL ST STE 205
YPSILANTI MI
48197-5374
US

V. Phone/Fax

Practice location:
  • Phone: 904-540-7855
  • Fax:
Mailing address:
  • Phone: 904-540-7855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: RADHA K BHATT
Title or Position: BUSINESS OWNER
Credential:
Phone: 904-540-7855