Healthcare Provider Details

I. General information

NPI: 1851680185
Provider Name (Legal Business Name): GENESIS COUNSELING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 EXECUTIVE DR SUITE C
HAMPTON VA
23666-6604
US

IV. Provider business mailing address

2202 EXECUTIVE DR SUITE C
HAMPTON VA
23666-6604
US

V. Phone/Fax

Practice location:
  • Phone: 757-827-7707
  • Fax:
Mailing address:
  • Phone: 757-827-7707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. CAMERON ASHWORTH
Title or Position: VP OF OPERATIONS
Credential:
Phone: 757-827-7707