Provider Demographics
NPI:1790564482
Name:COVIN, BRATISHA BRADLEY
Entity Type:Individual
Prefix:
First Name:BRATISHA
Middle Name:BRADLEY
Last Name:COVIN
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 1:33 LUKE DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31705-9010
Mailing Address - Country:US
Mailing Address - Phone:229-854-0390
Mailing Address - Fax:
Practice Address - Street 1:33 LUKE DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31705-9010
Practice Address - Country:US
Practice Address - Phone:229-854-0390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker