Healthcare Provider Details

I. General information

NPI: 1376305789
Provider Name (Legal Business Name): OPAL & WILLOW COUNSELING & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3248 JONAGOLD DR
HARRISBURG PA
17110-9119
US

IV. Provider business mailing address

3248 JONAGOLD DR
HARRISBURG PA
17110-9119
US

V. Phone/Fax

Practice location:
  • Phone: 717-350-0123
  • Fax:
Mailing address:
  • Phone: 717-350-0123
  • 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: DENISE LYNN VERCHIMAK
Title or Position: OWNER/THERAPIST
Credential: LPC
Phone: 717-350-0123