Provider Demographics
NPI:1518204601
Name:GENESIS PROJECT 1, INC.
Entity Type:Organization
Organization Name:GENESIS PROJECT 1, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL TEAM LEAD, COUNSELOR II
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:CHANIESE
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFTA
Authorized Official - Phone:704-778-6141
Mailing Address - Street 1:1015 PINEBOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-7050
Mailing Address - Country:US
Mailing Address - Phone:704-778-6141
Mailing Address - Fax:
Practice Address - Street 1:5108 REAGAN DR STE 14
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-1395
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:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8083A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health