Provider Demographics
NPI:1245389279
Name:WILLIAMS, OPAL DIONNE (MED CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:OPAL
Middle Name:DIONNE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-0029
Mailing Address - Country:US
Mailing Address - Phone:919-771-6830
Mailing Address - Fax:888-422-2757
Practice Address - Street 1:742 MCKNIGHT DR
Practice Address - Street 2:SUITE 221
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-7764
Practice Address - Country:US
Practice Address - Phone:919-771-6830
Practice Address - Fax:888-422-2757
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6914235Z00000X
SC4240235Z00000X
CA19026235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412369Medicaid