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General NPI Number Information
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NPI Number | 1427856533
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Entity Type | Organization
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Legal Business Name | METANOIA THERAPY AND CONSULTING
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 2280 S 11TH ST STE 238
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City | KALAMAZOO
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State | MI
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Zip | 49009-1910
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Country | US
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Telephone | 719-482-8009
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Fax |
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Provider Business Mailing Address
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Address Line | 6670 PLEASANTVIEW DR
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City | PORTAGE
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State | MI
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Zip | 49024-1035
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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 | MENTAL HEALTH THERAPIST
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Name | CANDACE A DAVIS
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Credential | LPC
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Telephone | 719-482-8009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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