Organization
COVENANT COUNSELING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK E, TIDSWORTH MDIV., MED, LMFT (CONSULTING DIRECTOR)
18036733634
Entity
Organization
Contact information
Practice address
1851 DAWSON BRANCH RD, SUMMERVILLE, SC 29483-5702
(843) 851-1806
Mailing address
196 BRIDGECREEK DR, GOOSE CREEK, SC 29445-5214
(843) 572-4217
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
2130
SC
Other
Enumeration date
06/21/2007
Last updated
08/22/2020
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