| Covenant Counseling Center, Inc. | |
|
600 2nd St Se Moultrie GA 31768-5514 | |
| (229) 890-2288 | |
| (229) 890-2289 |
| Full Name | Covenant Counseling Center, Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 600 2nd St Se, Moultrie, Georgia |
| Authorized Official Name and Position | Diane K Cerjan (PSYCHOLOGIST) |
| Authorized Official Contact | 2298902288 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Covenant Counseling Center, Inc. 600 2nd St Se Moultrie GA 31768-5514 Ph: (229) 890-2288 | Covenant Counseling Center, Inc. 600 2nd St Se Moultrie GA 31768-5514 Ph: (229) 890-2288 |
| NPI Number | 1730234204 |
|---|---|
| Provider Enumeration Date | 01/24/2007 |
| Last Update Date | 01/28/2009 |
| Medicare PECOS PAC ID | 1951496785 |
|---|---|
| Medicare Enrollment ID | O20071009000172 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730234204 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 002049 (Georgia) | Primary |
| Provider Name | Nick A Carden |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1710969654 PECOS PAC ID: 6406022540 Enrollment ID: I20111220000733 |
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