Provider Demographics
NPI:1114602570
Name:LIFE'S METAMORPHOSIS LLC
Entity Type:Organization
Organization Name:LIFE'S METAMORPHOSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WARDLAW
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:267-419-7846
Mailing Address - Street 1:7914 WALTHAM RD
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19012-1713
Mailing Address - Country:US
Mailing Address - Phone:215-407-0208
Mailing Address - Fax:267-427-8278
Practice Address - Street 1:201 YORK RD STE 1-564
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3200
Practice Address - Country:US
Practice Address - Phone:267-419-7846
Practice Address - Fax:267-427-8278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-21
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)