=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275490906
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | METANOIA THERAPY COLLECTIVE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2026
-----------------------------------------------------
Last Update Date | 01/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 STOUT ST
-----------------------------------------------------
City | YATESVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18640-3321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-543-2830
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 STOUT ST
-----------------------------------------------------
City | YATESVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18640-3321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-543-2830
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. SAVINA VAVLAS ORTIZ
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 570-709-9947
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------