| My Covenant Place | |
|
9701 Apollo Dr Ste 4114th Largo MD 20774-4783 | |
| (301) 577-7307 | |
| (301) 476-0076 |
| Full Name | My Covenant Place |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 9701 Apollo Dr Ste 4114th, Largo, Maryland |
| Authorized Official Name and Position | Latisha Carter (CEO/EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3015777307 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| My Covenant Place 10630 Little Patuxent Pkwy Ste 113 Columbia MD 21044-6225 Ph: (410) 200-9290 | My Covenant Place 9701 Apollo Dr Ste 4114th Largo MD 20774-4783 Ph: (301) 577-7307 |
| NPI Number | 1164853669 |
|---|---|
| Provider Enumeration Date | 12/09/2013 |
| Last Update Date | 01/09/2023 |
| Certification Date | 01/09/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164853669 | NPI | - | NPPES |
| 19125M99 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Maryland) | Primary |
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