Provider Demographics
NPI:1710168059
Name:COVER
Entity Type:Organization
Organization Name:COVER
Other - Org Name:COMMUNITY OUTREACH TO VIETNAM ERA RETURNEES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:COATES
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:434-964-1910
Mailing Address - Street 1:PO BOX 1284
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-1284
Mailing Address - Country:US
Mailing Address - Phone:434-964-1910
Mailing Address - Fax:
Practice Address - Street 1:501 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-5541
Practice Address - Country:US
Practice Address - Phone:434-964-1910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001075251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management