Healthcare Provider Details

I. General information

NPI: 1679236202
Provider Name (Legal Business Name): VANESSA LORAIN ZIKOVSKY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VANESSA ARANGUA

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6212 FRIENDS AVE
WHITTIER CA
90601-3726
US

IV. Provider business mailing address

6212 FRIENDS AVE
WHITTIER CA
90601-3726
US

V. Phone/Fax

Practice location:
  • Phone: 865-964-3780
  • Fax:
Mailing address:
  • Phone: 865-964-3780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number009195
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: