Healthcare Provider Details

I. General information

NPI: 1306672407
Provider Name (Legal Business Name): METANOIA INTEGRATIVE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

472 QUAIL HILL DR
DEBARY FL
32713-4570
US

IV. Provider business mailing address

472 QUAIL HILL DR
DEBARY FL
32713-4570
US

V. Phone/Fax

Practice location:
  • Phone: 352-234-3337
  • Fax:
Mailing address:
  • Phone: 352-234-3337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. JUSTIN L HOECK
Title or Position: OWNER / THERAPIST
Credential: LMHC
Phone: 908-528-1301