Provider Demographics
NPI:1194936880
Name:COVENANT COMMUNITY DEVELPOMENT CORP
Entity type:Organization
Organization Name:COVENANT COMMUNITY DEVELPOMENT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-695-0684
Mailing Address - Street 1:1217 REV S HOWARD WOODSON JR WAY
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-4015
Mailing Address - Country:US
Mailing Address - Phone:609-695-0684
Mailing Address - Fax:609-396-1198
Practice Address - Street 1:1217 REV S HOWARD WOODSON JR WAY
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-4015
Practice Address - Country:US
Practice Address - Phone:609-695-0684
Practice Address - Fax:609-396-1198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251S00000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health