Organization
COVENANT 21ST CENTURY MINISTRIES, INC
Active
Other names
Covenant Place
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PORTIA DENEEN RAWLES PSY D (CLINICAL DIRECTOR)
(757) 493-2912
Entity
Organization
Contact information
Practice address
260 FILBERT ST, NORFOLK, VA 23505-4410
(757) 493-2912
(757) 493-2913
Mailing address
5301 PROVIDENCE RD, SUITE 20, VIRGINIA BEACH, VA 23464-4128
(757) 493-2912
(757) 493-2913
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
80714001
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508036054
—
VA
Enumeration date
03/11/2008
Last updated
04/14/2009
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