MEDICARE: COVINGTON HEALING SERVICES,PLLC

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
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1710614680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVINGTON HEALING SERVICES,PLLC

Provider Business Mailing Address
First Line	:	1184 LEMPSTER DR NW
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28027-4524
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14316 REESE BLVD W # B-837
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-7959
Country	:	US
Telephone Number	:	704-292-0216
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	JOSHUA TAYLOR WIGGINS
Credential	:
Telephone Number	:	704-498-7736

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	01/04/2023

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