Provider Demographics
NPI:1720540123
Name:COVAULT, JOHANNA LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:LYNN
Last Name:COVAULT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11416 LEADENHALL LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-9263
Mailing Address - Country:US
Mailing Address - Phone:980-505-9647
Mailing Address - Fax:
Practice Address - Street 1:250 BRANCHVIEW DR NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-3415
Practice Address - Country:US
Practice Address - Phone:704-796-8542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical