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General NPI Number Information
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NPI Number | 1487958716
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Entity Type | Organization
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Legal Business Name | GENESIS HOUSE, INC.
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Dates
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Enumeration Date | 12/30/2010
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Last Update Date | 04/11/2012
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Provider Practice Location Address
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Address Line | 549 COX RD SUITE A
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City | GASTONIA
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State | NC
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Zip | 28054-0628
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Country | US
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Telephone | 704-852-3778
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 551389
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City | GASTONIA
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State | NC
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Zip | 28055-1389
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Country | US
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Telephone | 704-852-3778
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | KELVIN HALL
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Credential |
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Telephone | 704-852-3778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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