Provider Demographics
NPI:1790494573
Name:COVENANT BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:COVENANT BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:NKEIRUKA
Authorized Official - Last Name:BEN-AGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-505-1775
Mailing Address - Street 1:5656 LIBERTY MANOR CIR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-3279
Mailing Address - Country:US
Mailing Address - Phone:571-505-1775
Mailing Address - Fax:
Practice Address - Street 1:5656 LIBERTY MANOR CIR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-3279
Practice Address - Country:US
Practice Address - Phone:571-505-1775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty