Provider Demographics
NPI:1447597604
Name:KNIGHT, OPAL (MA, MHA, LPC, BC-TMH)
Entity Type:Individual
Prefix:MRS
First Name:OPAL
Middle Name:
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:MA, MHA, LPC, BC-TMH
Other - Prefix:MS
Other - First Name:OPAL
Other - Middle Name:
Other - Last Name:GRAYSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:136 FORUM DR STE 4
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7980
Mailing Address - Country:US
Mailing Address - Phone:803-590-8924
Mailing Address - Fax:
Practice Address - Street 1:136 FORUM DR STE 4
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7980
Practice Address - Country:US
Practice Address - Phone:803-590-8924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012266101YP2500X
NC9276101YP2500X
SC5688101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional