Healthcare Provider Details

I. General information

NPI: 1811339351
Provider Name (Legal Business Name): THEODORE-JOEL U OPARAH LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 WEST BLVD
CHARLOTTE NC
28208-6705
US

IV. Provider business mailing address

2633 WEST BLVD
CHARLOTTE NC
28208-6705
US

V. Phone/Fax

Practice location:
  • Phone: 704-521-4977
  • Fax:
Mailing address:
  • Phone: 704-521-4977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10143
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: