Healthcare Provider Details

I. General information

NPI: 1104564343
Provider Name (Legal Business Name): OPAL COUNSELING AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 05/26/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 ANSYS DRIVE, SUITE 102
CANONSBURG PA
15317
US

IV. Provider business mailing address

308 6TH ST STE 102
MC DONALD PA
15057-1132
US

V. Phone/Fax

Practice location:
  • Phone: 412-952-3342
  • Fax:
Mailing address:
  • Phone: 412-952-3342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH DORNETTO
Title or Position: OWNER
Credential: LC
Phone: 412-952-3342