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Organization
GENESIS INNOVATIVE SOLUTIONS
Active
Organization
GENESIS INNOVATIVE SOLUTIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAKARA WHICHARD (CEO)
(252) 565-3796
Entity
Organization
Contact information
Practice address
323 CLIFTON ST STE 4, GREENVILLE, NC 27858-5053
(252) 565-3796
Mailing address
323 CLIFTON ST STE 4, GREENVILLE, NC 27858-5053
(252) 565-3796
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
NULL
101YM0800X
Mental Health Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
NULL
Other
Enumeration date
12/22/2022
Last updated
12/30/2022
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