Provider Demographics
NPI:1306465257
Name:INNOVATIVE COUNSELING GROUP LLC
Entity type:Organization
Organization Name:INNOVATIVE COUNSELING GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNATHAN
Authorized Official - Middle Name:HAYES
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LSATP
Authorized Official - Phone:804-658-6760
Mailing Address - Street 1:PO BOX 38031
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-0831
Mailing Address - Country:US
Mailing Address - Phone:804-804-6586
Mailing Address - Fax:
Practice Address - Street 1:2530 PROFESSIONAL RD STE 201
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-3217
Practice Address - Country:US
Practice Address - Phone:804-658-6760
Practice Address - Fax:804-658-7195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-10
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty