Provider Demographics
NPI:1235772575
Name:COVENANT PSYCHIATRIC AND MENTAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:COVENANT PSYCHIATRIC AND MENTAL HEALTH SERVICES, LLC
Other - Org Name:COVENANT PSYCHIATRIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FOLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALOBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-361-5925
Mailing Address - Street 1:2607 BOX TREE DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-9306
Mailing Address - Country:US
Mailing Address - Phone:202-361-5925
Mailing Address - Fax:
Practice Address - Street 1:8507 OXON HILL RD # S200-4
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-4766
Practice Address - Country:US
Practice Address - Phone:301-747-4460
Practice Address - Fax:301-747-4576
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COVENANT PSYCHIATRIC AND MENTAL HEALTH SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-18
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty