Provider Demographics
NPI:1073271615
Name:NZINGA MIND AND HEART
Entity Type:Organization
Organization Name:NZINGA MIND AND HEART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TREVAUGHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS-NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-715-6793
Mailing Address - Street 1:128 S EAST ST UNIT 627
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46308-3450
Mailing Address - Country:US
Mailing Address - Phone:866-220-0238
Mailing Address - Fax:866-220-0238
Practice Address - Street 1:5 WASHINGTON ST STE 300
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4769
Practice Address - Country:US
Practice Address - Phone:866-220-0238
Practice Address - Fax:866-220-0238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty