Provider Demographics
NPI:1629177290
Name:COVENANT COUNSELING MINISTRIES INC
Entity Type:Organization
Organization Name:COVENANT COUNSELING MINISTRIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERRELL
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CRNP, PMH-F
Authorized Official - Phone:301-777-0633
Mailing Address - Street 1:907 SETON DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1817
Mailing Address - Country:US
Mailing Address - Phone:301-777-0633
Mailing Address - Fax:240-362-7110
Practice Address - Street 1:907 SETON DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1817
Practice Address - Country:US
Practice Address - Phone:301-777-0633
Practice Address - Fax:240-362-7110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2243101YP2500X
MDR063139163WP0809X
MDR067998163WP0809X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD953LMedicare ID - Type Unspecified