Provider Demographics
NPI:1912291097
Name:VIVIAN
Entity Type:Organization
Organization Name:VIVIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING TECHNICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNBAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-922-2651
Mailing Address - Street 1:4615 GOVERNMENT ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-5922
Mailing Address - Country:US
Mailing Address - Phone:225-922-2651
Mailing Address - Fax:
Practice Address - Street 1:4615 GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-5922
Practice Address - Country:US
Practice Address - Phone:225-922-2651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health