Provider Demographics
NPI:1811339351
Name:OPARAH, THEODORE-JOEL U (LPC)
Entity type:Individual
Prefix:MR
First Name:THEODORE-JOEL
Middle Name:U
Last Name:OPARAH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-6705
Mailing Address - Country:US
Mailing Address - Phone:704-521-4977
Mailing Address - Fax:
Practice Address - Street 1:2633 WEST BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-6705
Practice Address - Country:US
Practice Address - Phone:704-521-4977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10143101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional