Organization
GENESIS PSYCHOLOGICAL SERVICES, LCC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MONIQUE E. MITCHELL (OWNER/MANAGER)
(252) 287-7989
Entity
Organization
Contact information
Practice address
723 MOUNT MORIAH RD, AHOSKIE, NC 27910-9371
(252) 287-7989
Mailing address
723 MOUNT MORIAH RD, AHOSKIE, NC 27910-9371
(252) 287-7989
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
2147
NC
103TC0700X
Clinical Psychologist
2147
NC
251S00000X
Community/Behavioral Health Agency
Primary
2147
NC
Other
Enumeration date
07/30/2007
Last updated
07/30/2007
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