=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033502695
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | METAMORPHOSIS COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2015
-----------------------------------------------------
Last Update Date | 03/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3202 TOWER OAKS BLVD SUITE 202
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20852-4219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-498-9282
-----------------------------------------------------
Fax | 301-770-4225
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3202 TOWER OAKS BLVD SUITE 202
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20852-4219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-498-9282
-----------------------------------------------------
Fax | 301-770-4225
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER AND PSYCHOTHERAPIST
-----------------------------------------------------
Name | CLAIRE DANIELLE BLATT
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 2404989282404989282
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | LC 5945
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------