Provider Demographics
NPI:1699007575
Name:COVINGTON, LADONNA TENNILLE
Entity Type:Individual
Prefix:
First Name:LADONNA
Middle Name:TENNILLE
Last Name:COVINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E. 15TH STREET
Mailing Address - Street 2:SUITE 340
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102
Mailing Address - Country:US
Mailing Address - Phone:817-332-2211
Mailing Address - Fax:817-332-5268
Practice Address - Street 1:100 E. 15TH STREET
Practice Address - Street 2:SUITE 340
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102
Practice Address - Country:US
Practice Address - Phone:817-332-2211
Practice Address - Fax:817-332-5268
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64097101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor