Healthcare Provider Details

I. General information

NPI: 1295501765
Provider Name (Legal Business Name): ROSALIND GAYLA ANDERSON-FENNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E BROAD ST # 1028
FUQUAY VARINA NC
27526-1960
US

IV. Provider business mailing address

921 E BROAD ST # 1028
FUQUAY VARINA NC
27526-1960
US

V. Phone/Fax

Practice location:
  • Phone: 866-793-3889
  • Fax:
Mailing address:
  • Phone: 317-431-4941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC019490
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: