Genesis Project 1

Primary specialty

Point of ServiceTaxonomy code 305S00000X

License

P009049 Issued in NC

Legal business name

GENESIS PROJECT 1

Practice address

5108 Reagan Dr
Suite 14
Charlotte, NC 28206-3103

Phone

(704) 596-0505

Fax

(704) 596-0507

NPI assigned

Jul 22, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Trasha Black, PHDNPI 1730119363

Title

Clinical Director

Phone

(704) 596-0505

Specialties & licenses 1

Addresses

Tax ID family

Genesis Project 1 Inc2 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.

• Genesis Project 1, Inc

  • Mental Health Counselor
  • Charlotte, NC
  • NPI 1326187469
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Trasha Jacquette Black, PHD, LPC, NCC

  • Professional Counselor
  • Charlotte, NC
  • NPI 1730119363
  NPD Authorized official

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

{
    "created_epoch": "1405987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405987200000",
    "number": "1417364480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5108 REAGAN DR",
            "address_2": "SUITE 14",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282063103",
            "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": "5108 REAGAN DR",
            "address_2": "SUITE 14",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282063103",
            "telephone_number": "704-596-0505",
            "fax_number": "704-596-0507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS PROJECT 1",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-22",
        "last_updated": "2014-07-22",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "TRASHA",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "704-596-0505",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "NC",
            "license": "P009049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Genesis Eye Center
• Genesis Finance Corporation
• Genesis Home Health Agency
• Genesis of Carolinas Home Care, LLC
• Genesis of Carolinas Home Care, LLC
• Genesis Project 1, Inc
• Genesis Project 1, Inc.
• Genesis Project Family Wellness Center, Inc.
• Genesis Project Medical Laboratory
• Genesis Rehab

• Point of Service in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Point of Service in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.