Provider Demographics
NPI:1417567934
Name:DEWALL, CASSANDRA COVINGTON (MED, LPC)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:COVINGTON
Last Name:DEWALL
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 PLEASANT HILL CT
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-6843
Mailing Address - Country:US
Mailing Address - Phone:409-718-1197
Mailing Address - Fax:
Practice Address - Street 1:8150 N. MAJOR DR.
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77713
Practice Address - Country:US
Practice Address - Phone:409-898-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79475101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health