| Covenant Counseling | |
|
851 S Mount Vernon Ave Ste 7a Colton CA 92324-3926 | |
| (760) 241-6044 | |
| Not Available |
| Full Name | Covenant Counseling |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 851 S Mount Vernon Ave Ste 7a, Colton, California |
| Authorized Official Name and Position | Clarence Carl Wilson (DIRECTOR) |
| Authorized Official Contact | 7602416044 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Covenant Counseling 851 S Mount Vernon Ave Ste 7a Colton CA 92324-3926 Ph: (760) 241-6044 | Covenant Counseling 851 S Mount Vernon Ave Ste 7a Colton CA 92324-3926 Ph: (760) 241-6044 |
| NPI Number | 1164967527 |
|---|---|
| Provider Enumeration Date | 12/21/2016 |
| Last Update Date | 05/18/2021 |
| Certification Date | 05/18/2021 |
| Medicare PECOS PAC ID | 2668824319 |
|---|---|
| Medicare Enrollment ID | O20240117004850 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164967527 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | LPCC2784 (California) | Primary |
| Provider Name | Clarence Carl Wilson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1033496245 PECOS PAC ID: 3577915222 Enrollment ID: I20240206000670 |
| Provider Name | Lelah Sharra Villalpando |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1376287334 PECOS PAC ID: 1658714647 Enrollment ID: I20240206004830 |
| Provider Name | Sienna Louise Ambrose |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1265656292 PECOS PAC ID: 7214371913 Enrollment ID: I20240221002935 |
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