Provider Demographics
NPI:1275767709
Name:THE GENESIS PROJECT
Entity Type:Organization
Organization Name:THE GENESIS PROJECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/COO
Authorized Official - Prefix:
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCREA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-251-6196
Mailing Address - Street 1:4441 SIX FORKS RD
Mailing Address - Street 2:#106-216
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5729
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 GILBERT ST
Practice Address - Street 2:#208
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3509
Practice Address - Country:US
Practice Address - Phone:919-251-6196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health