Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | LGP7267 | MD |
NPI | 1033620794 |
---|---|
Provider Name | Mariah Covington |
First Address | Washington, DC 20032-2605 |
Second Address | Washington, DC 20010-2927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2017 |
Last Update Date | 20/10/2017 |