Provider Demographics
NPI:1003093030
Name:MINOTT, OPAL HOPE (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:OPAL
Middle Name:HOPE
Last Name:MINOTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1083 SIMONTON HILL CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-3531
Mailing Address - Country:US
Mailing Address - Phone:770-375-0479
Mailing Address - Fax:678-985-4228
Practice Address - Street 1:1083 SIMONTON HILL CT
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-3531
Practice Address - Country:US
Practice Address - Phone:770-375-0479
Practice Address - Fax:678-985-4228
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0038931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA286447905AMedicaid