Provider Demographics
NPI:1174649347
Name:METAMORPHOSIS COUNSELING, INC
Entity Type:Organization
Organization Name:METAMORPHOSIS COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:CLIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:304-768-1401
Mailing Address - Street 1:2262 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WV
Mailing Address - Zip Code:25541-1004
Mailing Address - Country:US
Mailing Address - Phone:304-743-8047
Mailing Address - Fax:
Practice Address - Street 1:4501 MACCORKLE AVE SW
Practice Address - Street 2:SUITE 103
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1444
Practice Address - Country:US
Practice Address - Phone:304-768-1401
Practice Address - Fax:304-768-1402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV94101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty