Provider Demographics
NPI:1942762984
Name:CARRICO, OPAL POWELL (LPC)
Entity Type:Individual
Prefix:
First Name:OPAL
Middle Name:POWELL
Last Name:CARRICO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:OPAL
Other - Middle Name:MAE
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1605 CORNERSTONE RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:VA
Mailing Address - Zip Code:24348-3541
Mailing Address - Country:US
Mailing Address - Phone:276-768-9541
Mailing Address - Fax:
Practice Address - Street 1:770 W RIDGE RD STE 220
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1187
Practice Address - Country:US
Practice Address - Phone:276-223-3202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YA0400X
VA0701008505101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)