Healthcare Provider Details

I. General information

NPI: 1437063476
Provider Name (Legal Business Name): JENNIE RILEY LMFT, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3417 ANGUS RD
DURHAM NC
27705-5401
US

IV. Provider business mailing address

3417 ANGUS RD
DURHAM NC
27705-5401
US

V. Phone/Fax

Practice location:
  • Phone: 510-610-2005
  • Fax:
Mailing address:
  • Phone: 510-610-2005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number10273
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number87607
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: