NPI 1417364480

Genesis Project 1

Organisation Point of Service Charlotte, NC

Practice location

Address: 5108 Reagan Dr Suite 14, Charlotte, NC 28206-3103
Phone: (704) 596-0505
Fax: (704) 596-0507

Authorised official

Name: Trasha Black
Title: Clinical Director
Phone: (704) 596-0505

Registered specialties

Point of Service Primary

Managed Care Organizations Taxonomy 305S00000X Licence P009049 (NC)

Other Point of Service providers in North Carolina →

Registry record

NPI: 1417364480
Entity type: Organization
NPI issued: 22 Jul 2014
Record last updated: 22 Jul 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.