Healthcare Provider Details

I. General information

NPI: 1376354217
Provider Name (Legal Business Name): METANOIA GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 01/20/2025
Certification Date: 01/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9663 TIERRA GRANDE ST STE 104
SAN DIEGO CA
92126-4569
US

IV. Provider business mailing address

9663 TIERRA GRANDE ST STE 104
SAN DIEGO CA
92126-4569
US

V. Phone/Fax

Practice location:
  • Phone: 858-500-2434
  • Fax: 858-815-6646
Mailing address:
  • Phone: 858-500-2434
  • Fax: 858-815-6646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. DARLENE R TOWNES
Title or Position: PRESIDENT/CEO
Credential: PSY.D.
Phone: 858-500-2434