Healthcare Provider Details

I. General information

NPI: 1497670988
Provider Name (Legal Business Name): JENNA M MANNING M.S, LCAS, LMFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 WAKE FOREST RD
RALEIGH NC
27609-0010
US

IV. Provider business mailing address

4030 WAKE FOREST RD STE 349
RALEIGH NC
27609-0010
US

V. Phone/Fax

Practice location:
  • Phone: 818-588-8136
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number10506A
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: