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  7. NPI Record 1801473939

GENESIS CLINCAL SERVICES
Complete NPI Record 1801473939
Psychologist - Clinical in Charlotte, NC

NPI Status: Active since March 25, 2021

Contact Information

7400 CARMEL EXECUTIVE PARK DR STE 135
CHARLOTTE, NC
ZIP 28226
Phone: (704) 464-4910
Fax: (704) 230-0856

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider Business Mailing Address Fax Number
  12. Provider First Line Business Practice Location Address
  13. Provider Business Practice Location Address City Name
  14. Provider Business Practice Location Address State Name
  15. Provider Business Practice Location Address Postal Code
  16. Provider Business Practice Location Address Country Code If outside U S
  17. Provider Business Practice Location Address Telephone Number
  18. Provider Business Practice Location Address Fax Number
  19. Provider Enumeration Date
  20. Last Update Date
  21. Authorized Official Last Name
  22. Authorized Official First Name
  23. Authorized Official Middle Name
  24. Authorized Official Title or Position
  25. Authorized Official Telephone Number
  26. Healthcare Provider Taxonomy Code 1
  27. Healthcare Provider Primary Taxonomy Switch 1
  28. Healthcare Provider Taxonomy Code 2
  29. Healthcare Provider Primary Taxonomy Switch 2
  30. Healthcare Provider Taxonomy Code 3
  31. Healthcare Provider Primary Taxonomy Switch 3
  32. Healthcare Provider Taxonomy Code 4
  33. Healthcare Provider Primary Taxonomy Switch 4
  34. Healthcare Provider Taxonomy Code 5
  35. Healthcare Provider Primary Taxonomy Switch 5
  36. Healthcare Provider Taxonomy Code 6
  37. Healthcare Provider Primary Taxonomy Switch 6
  38. Healthcare Provider Taxonomy Code 7
  39. Healthcare Provider Primary Taxonomy Switch 7
  40. Healthcare Provider Taxonomy Code 8
  41. Healthcare Provider Primary Taxonomy Switch 8
  42. Healthcare Provider Taxonomy Code 9
  43. Healthcare Provider Primary Taxonomy Switch 9
  44. Healthcare Provider Taxonomy Code 10
  45. Healthcare Provider Primary Taxonomy Switch 10
  46. Healthcare Provider Taxonomy Code 11
  47. Healthcare Provider Primary Taxonomy Switch 11
  48. Healthcare Provider Taxonomy Code 12
  49. Healthcare Provider Primary Taxonomy Switch 12
  50. Is Organization Subpart
  51. Authorized Official Name Prefix Text
  52. Authorized Official Credential Text
  53. Healthcare Provider Taxonomy Group 1
  54. Healthcare Provider Taxonomy Group 2
  55. Healthcare Provider Taxonomy Group 3
  56. Healthcare Provider Taxonomy Group 4
  57. Healthcare Provider Taxonomy Group 5
  58. Healthcare Provider Taxonomy Group 6
  59. Healthcare Provider Taxonomy Group 7
  60. Healthcare Provider Taxonomy Group 8
  61. Healthcare Provider Taxonomy Group 9
  62. Healthcare Provider Taxonomy Group 10
  63. Healthcare Provider Taxonomy Group 11
  64. Healthcare Provider Taxonomy Group 12
  65. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1801473939. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1801473939
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 7400 CARMEL EXECUTIVE PARK DR STE 135
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: CHARLOTTE
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: NC
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 282268400
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 7044644910
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 7042300856
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 7400 CARMEL EXECUTIVE PARK DR STE 135
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: CHARLOTTE
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: NC
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 282268400
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 7044644910
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 7042300856
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 3/25/2021
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 3/25/2021
The date that a record was last updated or changed.
Authorized Official Last Name: KRASKA
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: CHAD
The first name of the authorized official.
Authorized Official Middle Name: W
The middle name of the authorized official.
Authorized Official Title or Position: OWNER, CLINICAL PSYCHOLOGIST
The title or position of the authorized official.
Authorized Official Telephone Number: 7044644910
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 101Y00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 103G00000X
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 103T00000X
Healthcare Provider Primary Taxonomy Switch 3: N
Healthcare Provider Taxonomy Code 4: 103TB0200X
Healthcare Provider Primary Taxonomy Switch 4: N
Healthcare Provider Taxonomy Code 5: 103TM1800X
Healthcare Provider Primary Taxonomy Switch 5: N
Healthcare Provider Taxonomy Code 6: 103TP0814X
Healthcare Provider Primary Taxonomy Switch 6: N
Healthcare Provider Taxonomy Code 7: 103TS0200X
Healthcare Provider Primary Taxonomy Switch 7: N
Healthcare Provider Taxonomy Code 8: 1041C0700X
Healthcare Provider Primary Taxonomy Switch 8: N
Healthcare Provider Taxonomy Code 9: 103TC2200X
Healthcare Provider Primary Taxonomy Switch 9: N
Healthcare Provider Taxonomy Code 10: 103TC1900X
Healthcare Provider Primary Taxonomy Switch 10: N
Healthcare Provider Taxonomy Code 11: 103TF0000X
Healthcare Provider Primary Taxonomy Switch 11: N
Healthcare Provider Taxonomy Code 12: 103TC0700X
Healthcare Provider Primary Taxonomy Switch 12: Y
Is Organization Subpart: N
Authorized Official Name Prefix Text: DR.
Authorized Official Credential Text: PSYD
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 3: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 4: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 5: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 6: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 7: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 8: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 9: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 10: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 11: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 12: 193200000X MULTI-SPECIALTY GROUP
NPI Certification Date: 3/25/2021