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Organization
GENESIS PROJECT FAMILY WELLNESS CENTER, INC.
Active
Organization
GENESIS PROJECT FAMILY WELLNESS CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRASHA J BLACK PHD LCMHC (EXECUTIVE DIRECTOR)
(704) 596-0505
Entity
Organization
Contact information
Practice address
5104 REAGAN DR STE 5, CHARLOTTE, NC 28206-1392
(704) 596-0505
(704) 596-0507
Mailing address
5104 REAGAN DR STE 5, CHARLOTTE, NC 28206-1392
(704) 596-0505
(704) 596-0507
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
251B00000X
Case Management Agency
—
NULL
251C00000X
Developmentally Disabled Services Day Training Agency
—
NULL
251S00000X
Community/Behavioral Health Agency
—
NULL
251V00000X
Voluntary or Charitable Agency
—
NULL
261Q00000X
Clinic/Center
—
NULL
261QC1500X
Community Health Clinic/Center
Primary
—
NULL
261QF0050X
Non-Surgical Family Planning Clinic/Center
—
NULL
261QH0100X
Health Service Clinic/Center
—
NULL
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
261QP2300X
Primary Care Clinic/Center
—
NULL
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
—
NULL
261QR1300X
Rural Health Clinic/Center
—
NULL
261QU0200X
Urgent Care Clinic/Center
—
NULL
Other
Enumeration date
05/28/2021
Last updated
05/28/2021
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