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General NPI Number Information
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NPI Number | 1063213908
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Entity Type | Organization
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Legal Business Name | METANOIA MIND AND WELLNESS PLLC
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 1558 UNION RD STE A
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City | GASTONIA
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State | NC
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Zip | 28054-2215
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Country | US
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Telephone | 704-323-6513
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Fax |
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Provider Business Mailing Address
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Address Line | 11 CONCORD COMMONS PL SW STE A16 STE 1013
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City | CONCORD
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State | NC
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Zip | 28027
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LATONJA PICKETT
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Credential | LCSW
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Telephone | 980-225-2880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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