Healthcare Provider Details

I. General information

NPI: 1235046848
Provider Name (Legal Business Name): JENNA ALYSE BERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 HERITAGE GREENS DR
WAKE FOREST NC
27587-4380
US

IV. Provider business mailing address

1025 HERITAGE GREENS DR
WAKE FOREST NC
27587-4380
US

V. Phone/Fax

Practice location:
  • Phone: 631-379-7556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number20397A
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: