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General NPI Number Information
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NPI Number | 1376648527
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Entity Type | Individual
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Provider Name | CAROL COVINGTON HACKNEY L.C.P.C.
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Gender | Female
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 500 W BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83702-5916
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Country | US
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Telephone | 208-336-3900
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Fax | 208-342-6553
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Provider Business Mailing Address
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Address Line | 500 W BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83702-5916
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Country | US
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Telephone | 208-336-3900
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Fax | 208-342-6553
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCPC-341
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License Number State | ID
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