Provider Demographics
NPI:1306672407
Name:METANOIA INTEGRATIVE COUNSELING, LLC
Entity type:Organization
Organization Name:METANOIA INTEGRATIVE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOECK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:908-528-1301
Mailing Address - Street 1:1313 MAUGANS AVE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-4030
Mailing Address - Country:US
Mailing Address - Phone:908-528-1301
Mailing Address - Fax:
Practice Address - Street 1:510 CO RD 466
Practice Address - Street 2:SUITE 207 OFFICE B
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159
Practice Address - Country:US
Practice Address - Phone:908-528-1301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health