Provider Demographics
NPI:1316158769
Name:COVINGTON, JACQUELYN B
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:B
Last Name:COVINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 DAN RD
Mailing Address - Street 2:
Mailing Address - City:ROBBINS
Mailing Address - State:NC
Mailing Address - Zip Code:27325-7237
Mailing Address - Country:US
Mailing Address - Phone:910-464-3160
Mailing Address - Fax:910-464-3160
Practice Address - Street 1:263 DAN RD
Practice Address - Street 2:
Practice Address - City:ROBBINS
Practice Address - State:NC
Practice Address - Zip Code:27325-7237
Practice Address - Country:US
Practice Address - Phone:910-464-3160
Practice Address - Fax:910-464-3160
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20270101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty