Healthcare Provider Details

I. General information

NPI: 1164338877
Provider Name (Legal Business Name): GENESIS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 SAINT BERNARD AVE
NEW ORLEANS LA
70116-1319
US

IV. Provider business mailing address

2022 SAINT BERNARD AVE
NEW ORLEANS LA
70116-1319
US

V. Phone/Fax

Practice location:
  • Phone: 202-644-1912
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KINGSLEY OGBUJI
Title or Position: OWNER
Credential: LPC
Phone: 202-644-1912