Healthcare Provider Details

I. General information

NPI: 1245160639
Provider Name (Legal Business Name): METANOIA THERAPY & WELLNESS LICENSED CLINICAL SOCIAL WORKER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 E BIRCH ST APT EE102
BREA CA
92821-5123
US

IV. Provider business mailing address

2108 N ST STE 16365
SACRAMENTO CA
95816-5712
US

V. Phone/Fax

Practice location:
  • Phone: 626-621-9545
  • Fax:
Mailing address:
  • Phone: 626-621-9545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LAUREN VELEZ
Title or Position: CEO
Credential:
Phone: 626-621-9545