Provider Demographics
NPI:1003040841
Name:GENUINE COUNSELING SERVICES PLLC.
Entity Type:Organization
Organization Name:GENUINE COUNSELING SERVICES PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:SMETAK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC/LCMHC
Authorized Official - Phone:704-674-7290
Mailing Address - Street 1:332 S YORK ST
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4052
Mailing Address - Country:US
Mailing Address - Phone:704-674-7290
Mailing Address - Fax:
Practice Address - Street 1:332 S YORK ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4052
Practice Address - Country:US
Practice Address - Phone:704-674-7290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5347101YP2500X
NC5372101YP2500X
NCC0077491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1003040841Medicaid