MEDICARE: PROJECT PURPOSE GSO INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1780562231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROJECT PURPOSE GSO INC.

Provider Business Mailing Address
First Line	:	111 W LEWIS ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-1343
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 W LEWIS ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-1343
Country	:	US
Telephone Number	:	336-447-3706
Fax Number	:

Authorized Official
Title or Position	:	CHAIR OF THE BOARD
Name	:	ASHLEY ANDERSON
Credential	:
Telephone Number	:	336-447-3706

Provider Enumeration Date	:	08/23/2025
Last Update Date	:	08/23/2025

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