Provider Demographics
NPI:1700384831
Name:ZODIAC HOLDING GROUP
Entity Type:Organization
Organization Name:ZODIAC HOLDING GROUP
Other - Org Name:INTEGRATIVE COUNSELING AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:VAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:318-459-8927
Mailing Address - Street 1:3611 GREENWAY PL
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2011
Mailing Address - Country:US
Mailing Address - Phone:318-459-8927
Mailing Address - Fax:
Practice Address - Street 1:3611 GREENWAY PL
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2011
Practice Address - Country:US
Practice Address - Phone:318-459-8927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)