Individual provider Active NPI

Luis Velarde Gensollen, LCSW, LCAS-A

  • Clinical Social Worker
  • Fayetteville, NC
National Provider Identifier
1295688067
Registry record updated Mar 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C019550 Issued in NC
Practice address
3505 Village Dr
Fayetteville, NC 28304-4513
Phone
(910) 500-1800
Fax
(910) 500-1795
NPI assigned
Feb 19, 2026
Last updated
Mar 23, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X C019550 NC Primary

Addresses

Primary practice location

3505 Village Dr
Fayetteville, NC 28304-4513

Mailing address

3505 Village Dr
Fayetteville, NC 28304-4513
Phone (910) 500-1800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260505003772 NC Practitioner - Clinical Social Worker 4688142987 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

192 Greenwich Dr
Sanford, NC 27330-8828

1921 Ransom PL
Nashville, TN 37217-3841

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
C019550NCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Centerstone of Tennesse Inc. CurrentSince Feb 21, 2026 Accepting new patients
Centerstone of Tennessee, Inc. PastSince Feb 21, 2026 Accepting new patients

Locations

3505 Village Dr
Fayetteville, NC 28304
Phone (910) 323-0065

3505 Village Dr
Ste 101
Fayetteville, NC 28304
Phone (615) 463-6669

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1771459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774224000000",
    "number": "1295688067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3505 VILLAGE DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044513",
            "telephone_number": "910-500-1800",
            "fax_number": "910-500-1795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3505 VILLAGE DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044513",
            "telephone_number": "910-500-1800",
            "fax_number": "910-500-1795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VELARDE GENSOLLEN",
        "first_name": "LUIS",
        "credential": "LCSW, LCAS-A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-02-19",
        "last_updated": "2026-03-23",
        "certification_date": "2026-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C019550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.