Genesis Psychological Services, LCC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

2147 Issued in NC

Legal business name

GENESIS PSYCHOLOGICAL SERVICES, LCC

Practice address

723 Mount Moriah Rd
Ahoskie, NC 27910-9371

Phone

(252) 287-7989

NPI assigned

Jul 30, 2007

Last updated

Jul 30, 2007By 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

Mrs. Monique E. Mitchell

Title

Owner/Manager

Phone

(252) 287-7989

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1185753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185753600000",
    "number": "1558551101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "723 MOUNT MORIAH RD",
            "city": "AHOSKIE",
            "state": "NC",
            "postal_code": "279109371",
            "telephone_number": "252-287-7989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "723 MOUNT MORIAH RD",
            "city": "AHOSKIE",
            "state": "NC",
            "postal_code": "279109371",
            "telephone_number": "252-287-7989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS PSYCHOLOGICAL SERVICES, LCC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-30",
        "last_updated": "2007-07-30",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "MONIQUE",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "252-287-7989",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "2147",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "2147",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "2147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Ahoskie, NC
• Providers in Ahoskie, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2007; 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.