Provider Demographics
NPI:1407617434
Name:COVENANT COUNSELING PLLC
Entity Type:Organization
Organization Name:COVENANT COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:JORDAN-BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC-A
Authorized Official - Phone:252-285-2015
Mailing Address - Street 1:4535 AARON LN
Mailing Address - Street 2:
Mailing Address - City:ELM CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27822-8600
Mailing Address - Country:US
Mailing Address - Phone:252-363-5588
Mailing Address - Fax:
Practice Address - Street 1:800 N PARKER ST
Practice Address - Street 2:
Practice Address - City:ELM CITY
Practice Address - State:NC
Practice Address - Zip Code:27822-9225
Practice Address - Country:US
Practice Address - Phone:252-363-5588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty