Individual provider Active NPI

Larry L Covington, CDCA

  • Addiction (Substance Use Disorder) Counselor
  • Massillon, OH
National Provider Identifier
1477052389
Registry record updated Nov 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
CDCA.167710 Issued in OH
Practice address
1680 Nave Rd SE
Massillon, OH 44646-9604
Phone
(330) 830-8740
Fax
(330) 860-0912
NPI assigned
Feb 6, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X
Addiction (Substance Use Disorder) Counselor 101YA0400X CDCA.167710 OH Primary

Addresses

Primary practice location

1680 Nave Rd SE
Massillon, OH 44646-9604

Mailing address

625 Cleveland Ave NW
Canton, OH 44702-1805
Phone (330) 455-0374

Other identifiers 1

IdentifierTypeStateIssuer
0300548MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
CDCA.167710OHMDAddiction (Substance Use Disorder) Counselor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1517875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542672000000",
    "number": "1477052389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 CLEVELAND AVE NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447021805",
            "telephone_number": "330-455-0374",
            "fax_number": "330-453-6716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1680 NAVE RD SE",
            "city": "MASSILLON",
            "state": "OH",
            "postal_code": "446469604",
            "telephone_number": "330-830-8740",
            "fax_number": "330-860-0912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COVINGTON",
        "first_name": "LARRY",
        "middle_name": "L",
        "credential": "CDCA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-06",
        "last_updated": "2018-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "CDCA.167710",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0300548",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Massillon, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.