Healthcare Provider Details

I. General information

NPI: 1215503974
Provider Name (Legal Business Name): OPAL DAWN MARIA RITCHIE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 HICKORY PARK DR STE A
GLEN ALLEN VA
23059-2628
US

IV. Provider business mailing address

5230 HICKORY PARK DR STE A
GLEN ALLEN VA
23059-2628
US

V. Phone/Fax

Practice location:
  • Phone: 804-220-1159
  • Fax:
Mailing address:
  • Phone: 804-220-1159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904012931
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: