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General NPI Number Information
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NPI Number | 1326187469
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Entity Type | Organization
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Legal Business Name | GENESIS PROJECT 1, INC
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/27/2020
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Provider Practice Location Address
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Address Line | 5104 REAGAN DR STE 5
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City | CHARLOTTE
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State | NC
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Zip | 28206-1392
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Country | US
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Telephone | 704-596-0505
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 560723
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City | CHARLOTTE
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State | NC
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Zip | 28256-0723
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Country | US
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Telephone | 704-596-0505
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Fax | 704-596-0507
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Authorized Official
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Title or Position | MANAGER
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Name | MS. SYLVIA L. GRIER
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Credential | MSO
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Telephone | 704-596-0505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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