Basic Information
| Provider Information | |||||||||
| NPI: | 1801339353 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | METANOIA COUNSELING PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3037 W INA RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857412290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203533137 | ||||||||
| FaxNumber: | 5203533137 | ||||||||
| Practice Location | |||||||||
| Address1: | 3037 W INA RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857412290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203533137 | ||||||||
| FaxNumber: | 5203533137 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2016 | ||||||||
| LastUpdateDate: | 11/30/2016 | ||||||||
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| AuthorizedOfficialLastName: | HARTUNG | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 5203533137 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCSW-12863 | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.