MEDICARE: JAILYN S WEAVER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1205700994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAILYN S WEAVER

Provider Business Mailing Address
First Line	:	8610 BRITTDALE LN APT 305
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-6275
Country	:	US
Telephone Number	:	919-996-0221
Fax Number	:

Provider Business Practice Location Address
First Line	:	8610 BRITTDALE LN APT 305
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-6275
Country	:	US
Telephone Number	:	919-996-0221
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2025
Last Update Date	:	01/12/2026

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Directions to “ JAILYN S WEAVER ” Practice Location

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