Provider Demographics
NPI:1205079415
Name:COVINGTON, EDNA M (LCADC)
Entity type:Individual
Prefix:MRS
First Name:EDNA
Middle Name:M
Last Name:COVINGTON
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 E ORMOND AVE
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2053
Mailing Address - Country:US
Mailing Address - Phone:856-428-1300
Mailing Address - Fax:
Practice Address - Street 1:19 E ORMOND AVE
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2053
Practice Address - Country:US
Practice Address - Phone:856-428-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00020400101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT-4378Other174400000X
NJ37LC00020400Other101YA0400X