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NPI Code Detail

MEDICARE: LUIS VELARDE GENSOLLEN LCSW, LCAS-A

MEDICARE: LUIS VELARDE GENSOLLEN LCSW, LCAS-A
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerC019550NC

General Provider Information

NPI Number : 1295688067
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUIS VELARDE GENSOLLEN LCSW, LCAS-A
Provider Business Mailing Address
First Line : 3505 VILLAGE DR
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28304-4513
Country : US
Telephone Number : 910-500-1800
Fax Number : 910-500-1795
Provider Business Practice Location Address
First Line : 3505 VILLAGE DR
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28304-4513
Country : US
Telephone Number : 910-500-1800
Fax Number : 910-500-1795
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2026
Last Update Date : 03/23/2026

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