Healthcare Provider Details

I. General information

NPI: 1952215634
Provider Name (Legal Business Name): METAVIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 TRAIL CREEK LN
SAVANNAH GA
31405-8157
US

IV. Provider business mailing address

159 TRAIL CREEK LN
SAVANNAH GA
31405-8157
US

V. Phone/Fax

Practice location:
  • Phone: 234-303-9785
  • Fax:
Mailing address:
  • Phone: 234-303-9785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: ENGELA GERTRUIDA HEPWORTH
Title or Position: PSYCHOTHERAPIST
Credential: LCSW
Phone: 234-303-9785