MEDICARE: LANA NICOLE COVINGTON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904008747	VA
2	1041C0700X	Clinical Social Worker	LSW0000006294	TN

General Provider Information

NPI Number	:	1225285026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANA NICOLE COVINGTON LCSW

Provider Business Mailing Address
First Line	:	403 PRINCETON RD
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2056
Country	:	US
Telephone Number	:	423-773-2940
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 PRINCETON RD
Second Line	:	SUITE #2
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2056
Country	:	US
Telephone Number	:	423-773-2940
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2008
Last Update Date	:	05/17/2016

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Directions to “ LANA NICOLE COVINGTON LCSW” Practice Location

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