Provider Demographics
NPI:1275735649
Name:ALACHUA COUNTY METAMORPHOSIS
Entity Type:Organization
Organization Name:ALACHUA COUNTY METAMORPHOSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORONA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:352-955-2450
Mailing Address - Street 1:4201 SW 21ST PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-4282
Mailing Address - Country:US
Mailing Address - Phone:352-955-2450
Mailing Address - Fax:352-955-2452
Practice Address - Street 1:4201 SW 21ST PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-4282
Practice Address - Country:US
Practice Address - Phone:352-955-2450
Practice Address - Fax:352-955-2452
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALACHUA COUNTY BOCC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-05
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0301AD050101324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility