NPIMap

Organization Active NPI

Genesis Project 1, Inc

  • Mental Health Counselor
  • Charlotte, NC
National Provider Identifier
1326187469
Registry record updated Aug 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
GENESIS PROJECT 1, INC
Practice address
5104 Reagan Dr Ste 5
Charlotte, NC 28206-1392
Phone
(704) 596-0505
NPI assigned
Feb 5, 2007
Last updated
Aug 27, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2020

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

Authorized official

Name
Ms. Sylvia L. Grier, MSO
Title
Manager
Phone
(704) 596-0505

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU Primary
Professional Counselor 101YP2500X NU
Social Worker 104100000X NU
Clinical Social Worker 1041C0700X NU

Addresses

Primary practice location

5104 Reagan Dr Ste 5
Charlotte, NC 28206-1392

Mailing address

PO Box 560723
Charlotte, NC 28256-0723
Phone (704) 596-0505

Other practice location 1

5108 Reagan Dr
Suite 14
Charlotte, NC 28206-3103
Phone (704) 596-0505

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180622001539 NC Part B Supplier - Clinic/Group Practice 9335494939 Receives reassigned benefits from 2 practitioners
Practice locations: Charlotte, NC

National Provider Directory

National Provider Directory
Tax ID family
Genesis Project 12 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598486400000",
    "number": "1326187469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 560723",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282560723",
            "telephone_number": "704-596-0505",
            "fax_number": "704-596-0507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5104 REAGAN DR STE 5",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282061392",
            "telephone_number": "704-596-0505"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5108 Reagan Dr",
            "address_2": "Suite 14",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282063103",
            "country_code": "US",
            "telephone_number": "704-596-0505",
            "fax_number": "704-596-0507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GENESIS PROJECT 1, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2020-08-27",
        "certification_date": "2020-08-27",
        "status": "A",
        "authorized_official_last_name": "GRIER",
        "authorized_official_first_name": "SYLVIA",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "704-596-0505",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSO"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.