Organization
GENESIS PROJECT 1
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRASHA BLACK PHD (CLINICAL DIRECTOR)
(704) 596-0505
Entity
Organization
Contact information
Practice address
5108 REAGAN DR, SUITE 14, CHARLOTTE, NC 28206-3103
(704) 596-0505
(704) 596-0507
Mailing address
5108 REAGAN DR, SUITE 14, CHARLOTTE, NC 28206-3103
(704) 596-0505
(704) 596-0507
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
P009049
NC
Other
Enumeration date
07/22/2014
Last updated
07/22/2014
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