Healthcare Provider Details

I. General information

NPI: 1073119244
Provider Name (Legal Business Name): LAUREN PENLEY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 RIVA RIDGE DR
FAIRVIEW NC
28730-9764
US

IV. Provider business mailing address

209 RIVA RIDGE DR
FAIRVIEW NC
28730-9764
US

V. Phone/Fax

Practice location:
  • Phone: 828-222-3914
  • Fax:
Mailing address:
  • Phone: 828-222-3914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717002704
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2414
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: