Provider Demographics
NPI:1376706200
Name:GENERATIONS HEALTH SERVICES
Entity Type:Organization
Organization Name:GENERATIONS HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AGYENIM
Authorized Official - Middle Name:
Authorized Official - Last Name:AKUAMOAH-BOATENG
Authorized Official - Suffix:
Authorized Official - Credentials:LPC LCAS
Authorized Official - Phone:910-291-9909
Mailing Address - Street 1:PO BOX 1887
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28353-1887
Mailing Address - Country:US
Mailing Address - Phone:910-291-9909
Mailing Address - Fax:910-291-9913
Practice Address - Street 1:911 ATKINSON ST
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-4718
Practice Address - Country:US
Practice Address - Phone:910-291-9909
Practice Address - Fax:910-291-9913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL 083 033251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8302175QMedicaid
NC8302175Medicaid