# GENESIS PROJECT FAMILY WELLNESS CENTER, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841866068
- **Authorized official:** DR. TRASHA J BLACK PHD LCMHC (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (704) 596-0505

## Contact information

- **Practice address:** 5104 REAGAN DR STE 5, CHARLOTTE, NC 28206-1392
- **Practice address phone:** (704) 596-0505
- **Practice address fax:** (704) 596-0507
- **Mailing address:** 5104 REAGAN DR STE 5, CHARLOTTE, NC 28206-1392
- **Mailing address phone:** (704) 596-0505
- **Mailing address fax:** (704) 596-0507

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 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