Provider Demographics
NPI:1609545003
Name:GENESIS TMS & WELLNESS LLC
Entity Type:Organization
Organization Name:GENESIS TMS & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IFEANYI
Authorized Official - Middle Name:M
Authorized Official - Last Name:OLELE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-213-9945
Mailing Address - Street 1:10337 DEMOCRACY LN STE B
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2551
Mailing Address - Country:US
Mailing Address - Phone:703-955-0915
Mailing Address - Fax:248-243-8804
Practice Address - Street 1:10337B DEMOCRACY LN
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2521
Practice Address - Country:US
Practice Address - Phone:703-955-0915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health