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General NPI Number Information
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NPI Number | 1396390274
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Entity Type | Organization
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Legal Business Name | COVENANT COUNSELING CENTER INC
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Dates
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Enumeration Date | 08/07/2019
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Last Update Date | 08/07/2019
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Provider Practice Location Address
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Address Line | 441 CLAY ST STE 2
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City | KINGSPORT
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State | TN
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Zip | 37660-3693
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Country | US
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Telephone | 423-765-0607
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Fax | 423-247-1117
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Provider Business Mailing Address
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Address Line | PO BOX 1323
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City | KINGSPORT
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State | TN
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Zip | 37662-1323
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. AMANDA BRIGHT TAYLOR
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Credential |
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Telephone | 423-765-0607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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