MEDICARE: GENESIS PROJECT 1, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	104100000X	Social Worker
3	1041C0700X	Clinical Social Worker
4	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1326187469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS PROJECT 1, INC

Provider Business Mailing Address
First Line	:	PO BOX 560723
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28256-0723
Country	:	US
Telephone Number	:	704-596-0505
Fax Number	:	704-596-0507

Provider Business Practice Location Address
First Line	:	5104 REAGAN DR STE 5
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28206-1392
Country	:	US
Telephone Number	:	704-596-0505
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. SYLVIA L. GRIER
Credential	:	MSO
Telephone Number	:	704-596-0505

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	08/27/2020

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Directions to “GENESIS PROJECT 1, INC ” Practice Location

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