Provider Demographics
NPI:1740522929
Name:OPOKU, HENRIETTA (MS, LPCC-S, LCPC,)
Entity type:Individual
Prefix:MS
First Name:HENRIETTA
Middle Name:
Last Name:OPOKU
Suffix:
Gender:F
Credentials:MS, LPCC-S, LCPC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2844 MACK RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5130
Mailing Address - Country:US
Mailing Address - Phone:513-328-1750
Mailing Address - Fax:
Practice Address - Street 1:5410 CAMELOT DR APT D
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-7455
Practice Address - Country:US
Practice Address - Phone:513-328-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.014006101YP2500X
171M00000X
OHE.1700368-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator