Provider Demographics
NPI:1467511477
Name:COVENANT COUNSELING LLC
Entity Type:Organization
Organization Name:COVENANT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LODICO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:989-835-8344
Mailing Address - Street 1:212 W WACKERLY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-3000
Mailing Address - Country:US
Mailing Address - Phone:989-835-8344
Mailing Address - Fax:989-837-8655
Practice Address - Street 1:212 W WACKERLY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-3000
Practice Address - Country:US
Practice Address - Phone:989-835-8344
Practice Address - Fax:989-837-8655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty