Provider Demographics
NPI:1760702781
Name:COVINGTON, JANA PRUETT (LCSW)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:PRUETT
Last Name:COVINGTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:
Other - Last Name:PRUETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:597 WILLARD AVE SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-1541
Mailing Address - Country:US
Mailing Address - Phone:404-502-7660
Mailing Address - Fax:
Practice Address - Street 1:5887 GLENRIDGE DR STE 230
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-9929
Practice Address - Country:US
Practice Address - Phone:317-721-6550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0042061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical