Individual provider Active NPI

Jennifer C Connolly, LCSW

  • Clinical Social Worker
  • Winston-Salem, NC
National Provider Identifier
1073862017
Registry record updated Jun 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C008749 Issued in NC
Practice address
725 N. Highland Ave
2ND Floor
Winston-Salem, NC 27101-4206
Phone
(336) 607-8501
Fax
(336) 725-4030
NPI assigned
Sep 6, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X P006709 NC
Clinical Social Worker 1041C0700X C008749 NC Primary

Addresses

Primary practice location

725 N. Highland Ave
2ND Floor
Winston-Salem, NC 27101-4206

Mailing address

3210 Fairhill Dr
Raleigh, NC 27612-3215
Phone (919) 256-0824

Other practice location 1

1901 Adams Farm Pkwy
Greensboro, NC 27407-6338
Phone (336) 722-7266

Other practice location 2

104 Cambridge Plaza Dr
Winston Salem, NC 27104-3556
Phone (336) 722-7266

Other practice location 3

1615 Polo Rd
Winston Salem, NC 27106-3831
Phone (336) 722-7266

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
P006709NCMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Solstas Lab Partners Group LLC Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781568000000",
    "number": "1073862017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3210 FAIRHILL DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276123215",
            "telephone_number": "919-256-0824",
            "fax_number": "919-256-0833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 N. HIGHLAND AVE",
            "address_2": "2ND FLOOR",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271014206",
            "telephone_number": "336-607-8501",
            "fax_number": "336-725-4030"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1901 Adams Farm Pkwy",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274076338",
            "country_code": "US",
            "telephone_number": "336-722-7266",
            "fax_number": "336-722-7266",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "104 Cambridge Plaza Dr",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271043556",
            "country_code": "US",
            "telephone_number": "336-722-7266",
            "fax_number": "336-201-0538",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1615 Polo Rd",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271063831",
            "country_code": "US",
            "telephone_number": "336-722-7266",
            "fax_number": "336-201-0538",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CONNOLLY",
        "first_name": "JENNIFER",
        "middle_name": "C",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-06",
        "last_updated": "2026-06-16",
        "certification_date": "2026-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NC",
            "license": "P006709",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C008749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston-Salem, NC

Sources for this page

Verify at the official NPI Registry.