Provider Demographics
NPI:1043894124
Name:THE COVINGTON WELLNESS CENTER, L.L.C.
Entity Type:Organization
Organization Name:THE COVINGTON WELLNESS CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:COVINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LCMHC
Authorized Official - Phone:910-787-0938
Mailing Address - Street 1:8305 FOXBOROUGH WAY
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-7806
Mailing Address - Country:US
Mailing Address - Phone:815-869-7956
Mailing Address - Fax:
Practice Address - Street 1:350 HOUBOLT RD STE 210
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-8305
Practice Address - Country:US
Practice Address - Phone:815-869-7956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)