Healthcare Provider Details

I. General information

NPI: 1023831930
Provider Name (Legal Business Name): GENESIS BARBARA CUESTA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MORSE ST NE APT 623
WASHINGTON DC
20002-7492
US

IV. Provider business mailing address

300 MORSE ST NE APT 623
WASHINGTON DC
20002-7492
US

V. Phone/Fax

Practice location:
  • Phone: 305-924-1504
  • Fax:
Mailing address:
  • Phone: 305-924-1504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPRC200001403
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: