# GENESIS INNOVATIVE SOLUTIONS

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

## Provider details

- **NPI number:** 1912619818
- **Authorized official:** TAKARA WHICHARD (CEO)
- **Authorized official phone:** (252) 565-3796

## Contact information

- **Practice address:** 323 CLIFTON ST STE 4, GREENVILLE, NC 27858-5053
- **Practice address phone:** (252) 565-3796
- **Mailing address:** 323 CLIFTON ST STE 4, GREENVILLE, NC 27858-5053
- **Mailing address phone:** (252) 565-3796

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |

## Other

- **Enumeration date:** 12/22/2022
- **Last updated:** 12/30/2022