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General NPI Number Information
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NPI Number | 1962059006
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Entity Type | Organization
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Legal Business Name | METAMORPHOSIS HEALTH AND WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 08/22/2019
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Last Update Date | 04/20/2020
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Provider Practice Location Address
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Address Line | 10106 KRAUSE RD STE 206
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City | CHESTERFIELD
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State | VA
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Zip | 23832-6572
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Country | US
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Telephone | 804-991-8799
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Fax | 804-777-7770
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Provider Business Mailing Address
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Address Line | 10106 KRAUSE RD STE 206
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City | CHESTERFIELD
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State | VA
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Zip | 23832-6572
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Country | US
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Telephone | 804-991-8799
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MONICA LATRIESE HOLLOWAY
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Credential | LPC, NCC
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Telephone | 757-389-3761
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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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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