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General NPI Number Information
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NPI Number | 1871003293
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Entity Type | Organization
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Legal Business Name | METAMORPHOSIS COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 10/11/2017
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Last Update Date | 10/11/2017
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Provider Practice Location Address
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Address Line | 106 FARMINGTON AVE STE 2B
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City | NEW BRITAIN
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State | CT
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Zip | 06053-2977
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Country | US
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Telephone | 860-902-7050
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Fax | 860-902-7050
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Provider Business Mailing Address
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Address Line | 106 FARMINGTON AVE STE 2B
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City | NEW BRITAIN
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State | CT
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Zip | 06053-2977
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Country | US
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Telephone | 860-902-7050
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Fax | 860-902-7050
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Authorized Official
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Title or Position | LICENSED DRUG AND ALCOHOL COUNSELOR
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Name | DENNISSE VAZQUEZ
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Credential | MSW, LADC
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Telephone | 860-902-7050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 000883
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License Number State | CT
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