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General NPI Number Information
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NPI Number | 1548670359
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Entity Type | Organization
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Legal Business Name | COVENANT COUNSELING & CONSULTATION SERVICES
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Dates
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Enumeration Date | 05/01/2014
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Last Update Date | 11/03/2016
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Provider Practice Location Address
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Address Line | 3214 TAZEWELL PIKE STE 203
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City | KNOXVILLE
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State | TN
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Zip | 37918-2578
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Country | US
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Telephone | 865-254-6045
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Fax | 865-337-7382
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Provider Business Mailing Address
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Address Line | 3214 TAZEWELL PIKE STE 203
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City | KNOXVILLE
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State | TN
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Zip | 37918-2578
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Country | US
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Telephone | 865-254-6045
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Fax | 865-337-7382
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MS. DONNA JUANITA MITCHELL
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Credential | LMSW
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Telephone | 865-254-6045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LSW0000007798
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC0000001551
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License Number State | TN
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