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General NPI Number Information
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NPI Number | 1568913341
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Entity Type | Organization
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Legal Business Name | COVENANT COUNSELING SERVICES, LLC.
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 1145 US HIGHWAY 80 W
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City | POOLER
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State | GA
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Zip | 31322-2200
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Country | US
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Telephone | 912-677-2941
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Fax |
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Provider Business Mailing Address
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Address Line | 105 REDROCK CT
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City | SAVANNAH
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State | GA
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Zip | 31407-4944
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Country | US
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Telephone | 912-677-2941
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MRS. TENEKA MILES
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Credential | LCSW
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Telephone | 912-677-2941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | CSW005469
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License Number State | GA
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