Provider Demographics
NPI:1760512008
Name:AVERHART, OPAL J
Entity Type:Individual
Prefix:
First Name:OPAL
Middle Name:J
Last Name:AVERHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 MCCOYS MILL RD
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-8411
Mailing Address - Country:US
Mailing Address - Phone:706-306-4410
Mailing Address - Fax:706-592-1823
Practice Address - Street 1:2011 MCCOYS MILL RD
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-8411
Practice Address - Country:US
Practice Address - Phone:706-306-4410
Practice Address - Fax:706-592-1823
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor