Genesis Reign Support Services LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

GENESIS REIGN SUPPORT SERVICES LLC

Practice address

6406 Bareback Ter
North Chesterfield, VA 23234-4195

Phone

(804) 926-3696

NPI assigned

Mar 13, 2023

Last updated

Oct 11, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Derrick Dwain Jack

Title

Owner

Phone

(804) 926-3696

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1678665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696982400000",
    "number": "1477254894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6406 BAREBACK TER",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232344195",
            "telephone_number": "804-926-3696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6406 BAREBACK TER",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232344195",
            "telephone_number": "804-926-3696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS REIGN SUPPORT SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-13",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A",
        "authorized_official_last_name": "JACK",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_middle_name": "DWAIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "804-926-3696",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marquita Rachelle Garrett, LPC
• Hillary Gary, MD
• Stephanie Gaskins, MSW, LMHP-S
• Afeez Babatunde Gbadamosi
• Genesis Outpatient Services
• Geneva Wellness Studio
• Gentle Guidance Services LLC
• Gentle Touch of Love, LLC
• Brittney Shanesse George, LPC-S, PMH-C
• Sarah Gernerd

• Community/Behavioral Health Agency in North Chesterfield, VA
• Providers in North Chesterfield, VA by specialty
• Community/Behavioral Health Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2023; 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.