Provider Demographics
NPI:1063005395
Name:COVERSON, DEMONICA LATICHA
Entity Type:Individual
Prefix:DR
First Name:DEMONICA
Middle Name:LATICHA
Last Name:COVERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 BERING CT
Mailing Address - Street 2:
Mailing Address - City:NOLENSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37135-9573
Mailing Address - Country:US
Mailing Address - Phone:615-668-0835
Mailing Address - Fax:
Practice Address - Street 1:4205 HILLSBORO PIKE STE 314
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-3339
Practice Address - Country:US
Practice Address - Phone:615-398-1292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker