Organization
GENESIS YOUTH & FAMILY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA JACKSON (CEO/OWNER)
(704) 940-0036
Entity
Organization
Contact information
Practice address
9700 RESEARCH DR, SUITE 122, CHARLOTTE, NC 28262-8552
(704) 940-0036
(704) 598-2632
Mailing address
9700 RESEARCH DR, SUITE 122, CHARLOTTE, NC 28262-8552
(704) 940-0036
(704) 598-2632
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6006860
—
NC
05
—
8302598
—
NC
05
—
8302598B
—
NC
05
—
8302598H
—
NC
Enumeration date
10/31/2008
Last updated
07/15/2010
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