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General NPI Number Information
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NPI Number | 1467511477
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Entity Type | Organization
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Legal Business Name | COVENANT COUNSELING LLC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 05/23/2011
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Provider Practice Location Address
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Address Line | 212 W WACKERLY ST SUITE 200
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City | MIDLAND
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State | MI
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Zip | 48640-3000
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Country | US
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Telephone | 989-835-8344
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Fax | 989-837-8655
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Provider Business Mailing Address
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Address Line | 212 W WACKERLY ST SUITE 200
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City | MIDLAND
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State | MI
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Zip | 48640-3000
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Country | US
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Telephone | 989-835-8344
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Fax | 989-837-8655
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Authorized Official
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Title or Position | MEMBER
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Name | MR. TERRY LYNN LODICO
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Credential | MA, LPC
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Telephone | 989-835-8344
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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 |
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License Number State | MI
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