Provider Demographics
NPI:1134257595
Name:COVENANT COUNSELING
Entity type:Organization
Organization Name:COVENANT COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ZEBERT
Authorized Official - Last Name:MOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:856-589-0800
Mailing Address - Street 1:465 WOODBURY GLASSBORO RD
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-4559
Mailing Address - Country:US
Mailing Address - Phone:856-589-0800
Mailing Address - Fax:856-589-0843
Practice Address - Street 1:465 WOODBURY GLASSBORO RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-4559
Practice Address - Country:US
Practice Address - Phone:856-589-0800
Practice Address - Fax:856-589-0843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ439600130OtherSS NUMBER- DYFS
NJ0025453Medicaid