MEDICARE: OPAL SPRINGS CLINICAL SOLUTIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1679436067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPAL SPRINGS CLINICAL SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	6650 RIVERS AVE STE 100
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-4809
Country	:	US
Telephone Number	:	803-716-9308
Fax Number	:

Provider Business Practice Location Address
First Line	:	6650 RIVERS AVE STE 100
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-4809
Country	:	US
Telephone Number	:	803-716-9308
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TOYISHA ADAMS
Credential	:	LPC
Telephone Number	:	803-716-9308

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	12/03/2025

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