Organization
COVENANT YOUTH EMPOWERMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN ROCHE JR. BACHELOR DEGREE (ADMINISTRATOR)
(404) 403-1253
Entity
Organization
Contact information
Practice address
1806 CHEDWORTH LN, STONE MOUNTAIN, GA 30087-2118
(404) 403-1253
Mailing address
1806 CHEDWORTH LN, STONE MOUNTAIN, GA 30087-2118
(404) 403-1253
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
Other
Enumeration date
09/22/2008
Last updated
08/23/2013
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