MEDICARE: COVENANT COUNSELING & CONSULTING LLC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YP2500X	Professional Counselor	2542	AL
3	101YP2500X	Professional Counselor	3080	AL
4	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1295111557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVENANT COUNSELING & CONSULTING LLC

Provider Business Mailing Address
First Line	:	251 JOHNSTON ST SE STE 100
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-2515
Country	:	US
Telephone Number	:	256-822-2375
Fax Number	:	256-584-2330

Provider Business Practice Location Address
First Line	:	251 JOHNSTON ST SE STE 100
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-2515
Country	:	US
Telephone Number	:	256-822-2375
Fax Number	:	256-584-2330

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. TRICIA M LANGENFELD
Credential	:
Telephone Number	:	256-822-2375

Provider Enumeration Date	:	08/09/2015
Last Update Date	:	01/11/2023

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