Provider Demographics
NPI:1073782850
Name:COVINGTON, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:COVINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:COVINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PRESIDENT
Mailing Address - Street 1:2194-A HILLCREST PLAZA
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-2114
Mailing Address - Country:US
Mailing Address - Phone:910-904-2840
Mailing Address - Fax:910-904-2847
Practice Address - Street 1:2194-A HILLCREST PLAZA
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-2114
Practice Address - Country:US
Practice Address - Phone:910-904-2840
Practice Address - Fax:910-904-2847
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300635BMedicaid
NC6601233Medicaid
NC8300217BMedicaid
NC3409665Medicaid