Organization
GENESIS HOUSE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHAKEENA BERNIQUE LEE MSW, LSW, ACSW, CAAD (EXECUTIVE DIRECTOR)
(570) 322-0520
Entity
Organization
Contact information
Practice address
800 WEST 4TH STREET, STEG-01, WILLIAMSPORT, PA 17701-7201
(570) 322-0520
(570) 326-9674
Mailing address
800 WEST 4TH STREET, STEG-01, WILLIAMSPORT, PA 17701-7201
(570) 322-0520
(570) 326-9674
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
417015
PA
251K00000X
Public Health or Welfare Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007283800008
—
PA
01
—
807234
FPH NE PA
PA
01
—
999036
BC NE PA
PA
Enumeration date
09/22/2006
Last updated
10/27/2025
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