Provider Demographics
NPI:1972254647
Name:JOURNEY, GENILDA GENETTE (RCSWI)
Entity type:Individual
Prefix:MS
First Name:GENILDA
Middle Name:GENETTE
Last Name:JOURNEY
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 N DONNELLY ST STE 500
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-6968
Mailing Address - Country:US
Mailing Address - Phone:321-362-4176
Mailing Address - Fax:321-256-5176
Practice Address - Street 1:2110 N DONNELLY ST STE 500
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6968
Practice Address - Country:US
Practice Address - Phone:321-362-4176
Practice Address - Fax:321-256-5176
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 104100000X
FL1041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool