Provider Demographics
NPI:1326187469
Name:GENESIS PROJECT 1, INC
Entity Type:Organization
Organization Name:GENESIS PROJECT 1, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRIER
Authorized Official - Suffix:
Authorized Official - Credentials:MSO
Authorized Official - Phone:704-596-0505
Mailing Address - Street 1:PO BOX 560723
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28256-0723
Mailing Address - Country:US
Mailing Address - Phone:704-596-0505
Mailing Address - Fax:704-596-0507
Practice Address - Street 1:5104 REAGAN DR STE 5
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-1392
Practice Address - Country:US
Practice Address - Phone:704-596-0505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty