# COVENANT COUNSELING CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760688477
- **Authorized official:** MR. MARK E, TIDSWORTH MDIV., MED, LMFT (CONSULTING DIRECTOR)
- **Authorized official phone:** 18036733634

## Contact information

- **Practice address:** 1851 DAWSON BRANCH RD, SUMMERVILLE, SC 29483-5702
- **Practice address phone:** (843) 851-1806
- **Mailing address:** 196 BRIDGECREEK DR, GOOSE CREEK, SC 29445-5214
- **Mailing address phone:** (843) 572-4217

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | 2130 | SC | Yes |

## Other

- **Enumeration date:** 06/21/2007
- **Last updated:** 08/22/2020