Provider Demographics
NPI:1063579605
Name:COVERT, CARNICE SAMANTHA (PSYD)
Entity type:Individual
Prefix:
First Name:CARNICE
Middle Name:SAMANTHA
Last Name:COVERT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 538622
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-8622
Mailing Address - Country:US
Mailing Address - Phone:910-535-1211
Mailing Address - Fax:
Practice Address - Street 1:4000 ALBEMARLE ST NW
Practice Address - Street 2:#501
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016
Practice Address - Country:US
Practice Address - Phone:202-966-2033
Practice Address - Fax:202-966-2034
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMT0431225700000X
NC5224103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist