MEDICARE: GENESIS COUNSELING SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YP2500X	Professional Counselor
3	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1053719518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	364 S PINE ST STE A110
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29302-2654
Country	:	US
Telephone Number	:	864-515-6440
Fax Number	:	864-308-2442

Provider Business Practice Location Address
First Line	:	364 S PINE ST STE A110
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29302-2654
Country	:	US
Telephone Number	:	864-515-6440
Fax Number	:	864-308-2442

Authorized Official
Title or Position	:	OWNER/ THERAPIST
Name	:	STEPHANIE NICOLE PRATT
Credential	:	LPC, LAC, CACII, MAC
Telephone Number	:	864-515-6440

Provider Enumeration Date	:	12/16/2014
Last Update Date	:	09/06/2024

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