Provider Demographics
NPI:1558016840
Name:NEUROGENESIS LLC
Entity Type:Organization
Organization Name:NEUROGENESIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHOKAR
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:605-484-0560
Mailing Address - Street 1:10319 PICADILLY LN SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-2050
Mailing Address - Country:US
Mailing Address - Phone:605-484-0560
Mailing Address - Fax:
Practice Address - Street 1:1115 CHURCH ST NW STE J
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5980
Practice Address - Country:US
Practice Address - Phone:605-484-0560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health