Provider Demographics
NPI:1548670359
Name:COVENANT COUNSELING & CONSULTATION SERVICES
Entity type:Organization
Organization Name:COVENANT COUNSELING & CONSULTATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:JUANITA
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:865-254-6045
Mailing Address - Street 1:3214 TAZEWELL PIKE STE 203
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-2578
Mailing Address - Country:US
Mailing Address - Phone:865-254-6045
Mailing Address - Fax:865-337-7382
Practice Address - Street 1:3214 TAZEWELL PIKE STE 203
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-2578
Practice Address - Country:US
Practice Address - Phone:865-254-6045
Practice Address - Fax:865-337-7382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-01
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000007798104100000X
TNLPC0000001551101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6047941Medicaid