Genesis Autism Center, LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

GENESIS AUTISM CENTER, LLC

Practice address

2206 Executive Dr Ste a
Hampton, VA 23666-2583

Phone

(929) 436-3747

Fax

(757) 838-2573

NPI assigned

May 4, 2022

Organization subpart

No

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

Authorized official

Name

Mr. Cameron Severo Ashworth

Title

Owner

Phone

(757) 927-1527

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

Practitioners 2

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

• Shavon Champagne

  • Behavior Analyst
  • Hampton, VA
  • NPI 1932690070
  NPD (past)
• Arisa Phelps, RBT

  • Behavior Analyst
  • Hampton, VA
  • NPI 1235635442
  NPD (past)

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

{
    "created_epoch": "1651622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651622400000",
    "number": "1487399390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2202 EXECUTIVE DR STE C",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236666604",
            "telephone_number": "757-827-7707",
            "fax_number": "757-838-2573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2206 EXECUTIVE DR STE A",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236662583",
            "telephone_number": "929-436-3747",
            "fax_number": "757-838-2573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS AUTISM CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-04",
        "last_updated": "2022-05-04",
        "certification_date": "2022-05-04",
        "status": "A",
        "authorized_official_last_name": "ASHWORTH",
        "authorized_official_first_name": "CAMERON",
        "authorized_official_middle_name": "SEVERO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "757-927-1527",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.genesisautismcenter.com",
            "affiliation": "N",
            "endpointDescription": "Website Address",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Hampton",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2206 Executive Dr Ste A",
            "city": "Hampton",
            "state": "VA",
            "country_code": "US",
            "postal_code": "236662583",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jordan Benjamin Gayfield, DO
• GCD Healthcare, LLC
• Guerline Gelin, CSW
• Abigail Gellene-Beaudoin, LCSW
• Laura Gendron
• Genesis Counseling Center, Inc.
• Genesis Counseling Center, Inc.
• Genesis Healthcare
• Genesis Rehab Services
• Genesis Rehabilitation Services

• Behavior Analyst in Hampton, VA
• Providers in Hampton, VA by specialty
• Behavior Analyst in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2022; 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.