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General NPI Number Information
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NPI Number | 1457773160
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Entity Type | Organization
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Legal Business Name | NEW GENESIS CONSULTING SERVICES
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Dates
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Enumeration Date | 01/15/2014
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Last Update Date | 04/27/2016
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Provider Practice Location Address
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Address Line | 8227 CLOVERLEAF DR STE 303 SUITE G
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City | MILLERSVILLE
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State | MD
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Zip | 21108-1536
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Country | US
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Telephone | 410-987-1036
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Fax | 888-224-0984
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Provider Business Mailing Address
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Address Line | 112 W PENNSYLVANIA AVE SUITE 100
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City | BEL AIR
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State | MD
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Zip | 21014-3669
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Country | US
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Telephone | 410-838-8331
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Fax |
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Authorized Official
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Title or Position | OWNER OPERATOR/CLINICAL DIRECTOR
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Name | DR. SYRETTA R. JAMES
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Credential | PH.D.
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Telephone | 410-987-1036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 07685
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 04935
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License Number State | MD
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