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General NPI Number Information
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NPI Number | 1912696741
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Entity Type | Individual
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Provider Name | JACQUELYN L GENUS LMHC
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Gender | Female
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 4 AUTOMATION LN STE 100
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City | COLONIE
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State | NY
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Zip | 12205-1619
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Country | US
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Telephone | 518-919-3666
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Fax |
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Provider Business Mailing Address
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Address Line | 307 ANTON WAY
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City | GARNER
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State | NC
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Zip | 27529-6283
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Country | US
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Telephone | 931-896-6193
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 013005
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License Number State | NY
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