Provider Demographics
NPI:1457760118
Name:GENESIS COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:GENESIS COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-827-7707
Mailing Address - Street 1:2202 EXECUTIVE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6604
Mailing Address - Country:US
Mailing Address - Phone:757-827-7707
Mailing Address - Fax:757-838-2573
Practice Address - Street 1:2705 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-2207
Practice Address - Country:US
Practice Address - Phone:757-827-7707
Practice Address - Fax:757-838-2573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040020901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty