Organization
MY COVENANT PLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LATISHA CARTER (CEO/EXECUTIVE DIRECTOR)
(301) 577-7307
Entity
Organization
Contact information
Practice address
9701 APOLLO DR STE 4114TH, LARGO, MD 20774-4783
(301) 577-7307
(301) 476-0076
Mailing address
10630 LITTLE PATUXENT PKWY STE 113, COLUMBIA, MD 21044-6225
(410) 200-9290
(301) 476-0076
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19125M99
—
MD
Enumeration date
12/09/2013
Last updated
01/09/2023
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