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General NPI Number Information
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NPI Number | 1104564343
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Entity Type | Organization
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Legal Business Name | OPAL COUNSELING AND WELLNESS LLC
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Dates
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Enumeration Date | 05/26/2022
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Last Update Date | 05/26/2022
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Provider Practice Location Address
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Address Line | 2400 ANSYS DRIVE, SUITE 102
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City | CANONSBURG
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State | PA
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Zip | 15317
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Country | US
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Telephone | 412-952-3342
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Fax |
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Provider Business Mailing Address
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Address Line | 308 6TH ST STE 102
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City | MC DONALD
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State | PA
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Zip | 15057-1132
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Country | US
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Telephone | 412-952-3342
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELIZABETH DORNETTO
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Credential | LC
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Telephone | 412-952-3342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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