Genesis Project Medical Laboratory

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

GENESIS PROJECT MEDICAL LABORATORY

Practice address

1000 Anderson St Ste a
Charlotte, NC 28205-1216

Phone

(704) 596-0505

NPI assigned

Jun 29, 2020

Last updated

Mar 31, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

GENESIS PROJECT 1, INCAs reported in NPPES

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

Authorized official

Name

Dr. Trasha J Black, PHDNPI 1730119363

Title

Executive Director

Phone

(704) 596-0505

Specialties & licenses 1

Addresses

Electronic endpoints 1

Part of

Genesis Project 1 Inc

Locations

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.

• Trasha Jacquette Black, PHD, LPC, NCC

  • Professional Counselor
  • Charlotte, NC
  • NPI 1730119363
  NPD (past) Authorized official
• Keba Bosley

  • Clinical Social Worker
  • Mint Hill, NC
  • NPI 1649726589
  NPD
• Samantha Graves Suffren, MD

  • Psychiatry Physician
  • Salisbury, NC
  • NPI 1356370027
  NPD
• Marcia A. Todd Thompson, LCSW

  • Clinical Social Worker
  • Gastonia, NC
  • NPI 1619920055
  NPD

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

{
    "created_epoch": "1593388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617148800000",
    "number": "1700403425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5104 REAGAN DR STE 5",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282061392",
            "telephone_number": "704-596-0505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 ANDERSON ST STE A",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282051216",
            "telephone_number": "704-596-0505"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5104 Reagan Dr Ste 5",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282061392",
            "country_code": "US",
            "telephone_number": "704-596-0505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GENESIS PROJECT MEDICAL LABORATORY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GENESIS PROJECT 1, INC",
        "enumeration_date": "2020-06-29",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "TRASHA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "704-596-0505",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Charlotte",
            "affiliation": "N",
            "address_1": "1000 Anderson St Ste A",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282051216",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Genesis of Carolinas Home Care, LLC
• Genesis Project 1
• Genesis Project 1, Inc
• Genesis Project 1, Inc.
• Genesis Project Family Wellness Center, Inc.
• Genesis Rehab
• Genesis Rehab Services
• Genesis Rehabilitation
• Genesis Sports Management
• Genesis Youth & Family Services, LLC

• Clinical Medical Laboratory in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Clinical Medical Laboratory in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2021; 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.