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Organization
GENESIS HOUSE
Active
Organization
GENESIS HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KESTER MCDONALD (EXECUTIVE DIRECTOR)
(707) 552-5295
Entity
Organization
Contact information
Practice address
1149 WARREN AVE, VALLEJO, CA 94591-7512
(707) 552-5295
Mailing address
1149 WARREN AVE, VALLEJO, CA 94591-7512
(707) 552-5295
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
10/26/2021
Last updated
11/01/2021
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