Provider Demographics
NPI:1154086171
Name:WAYENBERG, LAUREN ELAINE KENLEY (LCSWA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELAINE KENLEY
Last Name:WAYENBERG
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ELAINE
Other - Last Name:KENLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5200 PARK RD STE 218B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3650
Mailing Address - Country:US
Mailing Address - Phone:866-700-1606
Mailing Address - Fax:
Practice Address - Street 1:5200 PARK RD STE 218B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3650
Practice Address - Country:US
Practice Address - Phone:866-700-1606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0169781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical