Healthcare Provider Details

I. General information

NPI: 1497436174
Provider Name (Legal Business Name): METANOIA WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W MAIN ST
CARNEGIE PA
15106-2427
US

IV. Provider business mailing address

101 W MAIN ST
CARNEGIE PA
15106-2427
US

V. Phone/Fax

Practice location:
  • Phone: 724-433-4068
  • Fax:
Mailing address:
  • Phone: 724-433-4068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ASHLEY NICOLE CYGNAROWICZ
Title or Position: OWNER
Credential: LPC
Phone: 724-433-4068