Healthcare Provider Details

I. General information

NPI: 1063808475
Provider Name (Legal Business Name): METAMORPHOSIS COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CEDAR HILL DR
MC MURRAY PA
15317-2529
US

IV. Provider business mailing address

418 FOUNTAIN ST # 1
CARNEGIE PA
15106-2811
US

V. Phone/Fax

Practice location:
  • Phone: 304-312-1192
  • Fax:
Mailing address:
  • Phone: 304-312-1192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC006851
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: REBECCA KLINE
Title or Position: OWNER, CLINICAL DIRECTOR
Credential:
Phone: 304-312-1192