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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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