Provider Demographics
NPI:1700297181
Name:METAMORPHOSIS COUNSELING AND WELLNESS SERVICES LLC
Entity Type:Organization
Organization Name:METAMORPHOSIS COUNSELING AND WELLNESS SERVICES LLC
Other - Org Name:METAMORPHOSIS COUNSELING SERVICES PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:NCC CCMHC LMHC
Authorized Official - Phone:321-272-5996
Mailing Address - Street 1:PO BOX 100156
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32910-0156
Mailing Address - Country:US
Mailing Address - Phone:321-272-5996
Mailing Address - Fax:321-473-8874
Practice Address - Street 1:665 DILLARD DR SE
Practice Address - Street 2:VIRTUAL/ONLINE ONLY
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909
Practice Address - Country:US
Practice Address - Phone:321-272-5996
Practice Address - Fax:321-473-8874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15855101YM0800X
TX69138101YP2500X
NC7677101YP2500X
FLMA86130225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty