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General NPI Number Information
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NPI Number | 1871966051
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Entity Type | Organization
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Legal Business Name | GENESIS COUNSELING CENTER
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Dates
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Enumeration Date | 11/10/2015
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Last Update Date | 11/10/2015
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Provider Practice Location Address
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Address Line | 336 S HALIFAX DR
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City | ORMOND BEACH
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State | FL
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Zip | 32176-8111
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Country | US
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Telephone | 386-677-5376
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Fax | 386-673-5347
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Provider Business Mailing Address
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Address Line | 336 S. HALIFAX DRIVE
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City | ORMOND BEACH
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State | FL
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Zip | 32176
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Country | US
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Telephone | 386-677-5376
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Fax | 386-673-5347
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. TIMOTHY LAWRENCE MCNEIL
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Credential | LMHC
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Telephone | 386-677-5376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | MH3217
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License Number State | FL
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