Healthcare Provider Details

I. General information

NPI: 1386125482
Provider Name (Legal Business Name): OPHELIA OPOKU-ACHEAMPONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OPHELIA AMA ASANTEWAA ADDAI BOATENG

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 WEDGEWOOD DR APT 9
MORGANTOWN WV
26505-2480
US

IV. Provider business mailing address

40 HIGH ST # 913
MORGANTOWN WV
26505-0172
US

V. Phone/Fax

Practice location:
  • Phone: 540-746-1830
  • Fax:
Mailing address:
  • Phone: 540-746-1830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00944888
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: