| Genesis Project 1, Inc | |
|
5104 Reagan Dr Ste 5 Charlotte NC 28206-1392 | |
| (704) 596-0505 | |
| Not Available |
| Full Name | Genesis Project 1, Inc |
|---|---|
| Speciality | Counselor |
| Location | 5104 Reagan Dr Ste 5, Charlotte, North Carolina |
| Authorized Official Name and Position | Sylvia L. Grier (MANAGER) |
| Authorized Official Contact | 7045960505 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis Project 1, Inc Po Box 560723 Charlotte NC 28256-0723 Ph: (704) 596-0505 | Genesis Project 1, Inc 5104 Reagan Dr Ste 5 Charlotte NC 28206-1392 Ph: (704) 596-0505 |
| NPI Number | 1326187469 |
|---|---|
| Provider Enumeration Date | 02/05/2007 |
| Last Update Date | 08/27/2020 |
| Certification Date | 08/27/2020 |
| Medicare PECOS PAC ID | 9335494939 |
|---|---|
| Medicare Enrollment ID | O20180622001539 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326187469 | NPI | - | NPPES |
| Provider Name | Samantha G Suffren |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356370027 PECOS PAC ID: 1658379425 Enrollment ID: I20061110000327 |
| Provider Name | Marcia Todd Thompson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619920055 PECOS PAC ID: 2365571056 Enrollment ID: I20100518000419 |
| Provider Name | Keba Bosley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649726589 PECOS PAC ID: 7012256068 Enrollment ID: I20190308001312 |
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