Provider Demographics
NPI:1649547399
Name:COVINGTON, JOSEPH ALEXANDER JR (BA)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ALEXANDER
Last Name:COVINGTON
Suffix:JR
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3707 E SHIELDS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-7029
Mailing Address - Country:US
Mailing Address - Phone:559-229-9040
Mailing Address - Fax:
Practice Address - Street 1:2550 WEST CLINTON AVE, R, S, Y, D, P
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-9370
Practice Address - Country:US
Practice Address - Phone:559-417-5992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CAC033850715101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC033850715OtherCCAPP