Provider Demographics
NPI:1619283538
Name:NEW COVENANT COUNSELING CARE
Entity Type:Organization
Organization Name:NEW COVENANT COUNSELING CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN
Authorized Official - Phone:770-474-1086
Mailing Address - Street 1:522 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6313
Mailing Address - Country:US
Mailing Address - Phone:770-474-1086
Mailing Address - Fax:770-474-3338
Practice Address - Street 1:522 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6313
Practice Address - Country:US
Practice Address - Phone:770-474-1086
Practice Address - Fax:770-474-3338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2904261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health