Provider Demographics
NPI:1104557057
Name:COVINGTON, TIMOTHY GERMAINE JR (LCMHCA)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:GERMAINE
Last Name:COVINGTON
Suffix:JR
Gender:M
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 N DUDLEY ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-3132
Mailing Address - Country:US
Mailing Address - Phone:336-340-8928
Mailing Address - Fax:
Practice Address - Street 1:209 N DUDLEY ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-3132
Practice Address - Country:US
Practice Address - Phone:336-340-8928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17566101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health