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General NPI Number Information
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NPI Number | 1558763540
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Entity Type | Organization
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Legal Business Name | GENESIS COUNSELING CENTER, INC.
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Dates
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Enumeration Date | 09/22/2014
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Last Update Date | 09/22/2014
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Provider Practice Location Address
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Address Line | 2003 LINCOLN DR W STE C
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City | MARLTON
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State | NJ
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Zip | 08053-1529
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Country | US
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Telephone | 856-596-8007
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Fax | 856-596-8699
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Provider Business Mailing Address
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Address Line | 566 HADDON AVE
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City | COLLINGSWOOD
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State | NJ
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Zip | 08108-1444
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Country | US
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Telephone | 856-858-9314
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Fax | 856-858-5672
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Authorized Official
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Title or Position | VICE PRESIDENT OF SUPPORT SERVICES
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Name | KAREN COLE
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Credential |
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Telephone | 856-858-9314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 2000171
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License Number State | NJ
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