Healthcare Provider Details

I. General information

NPI: 1053298885
Provider Name (Legal Business Name): GENERATIONAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 EAST BLVD
CHARLOTTE NC
28203-5113
US

IV. Provider business mailing address

601 W 24TH ST
CHARLOTTE NC
28206-2516
US

V. Phone/Fax

Practice location:
  • Phone: 704-363-8589
  • Fax:
Mailing address:
  • Phone: 704-363-8589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE COFFINO
Title or Position: CEO
Credential:
Phone: 704-363-8589