Healthcare Provider Details

I. General information

NPI: 1871153197
Provider Name (Legal Business Name): JESSICA CHENILLE LAZENBY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7610 FALLS OF NEUSE RD STE 290
RALEIGH NC
27615-3307
US

IV. Provider business mailing address

7610 FALLS OF NEUSE RD STE 290
RALEIGH NC
27615-3307
US

V. Phone/Fax

Practice location:
  • Phone: 919-321-9702
  • Fax: 919-321-9703
Mailing address:
  • Phone: 919-321-9702
  • Fax: 919-321-9703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC018639
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: