Jenny Renville, DHA, MA, LCMHCA, NCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

A16484 Issued in NC

Practice address

104 Waxhaw Professional Park Dr Ste D
Waxhaw, NC 28173-5020

Phone

(704) 277-9009

NPI assigned

Jul 15, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

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.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Liberty Univ College of Osteopathic Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Presbyterian Samaritan Counseling CenterGroup PAC ID 2264971779, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/25089/brand/1/csg/1/fhir/r4

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.

• Lifepath Holistic Counseling and Consulting, PLLC.

  • Professional Counselor
  • Waxhaw, NC
  • NPI 1083338032
  Medicare reassignment NPD Authorized official
• Presbyterian Samaritan Counseling Center

  • Mental Health Counselor
  • Charlotte, NC
  • NPI 1871679464
  Medicare reassignment Care Compare group NPD
• Brightside Medical of New Jersey, P.C.

  • Psychiatry Physician
  • San Francisco, CA
  • NPI 1811524754

  NC

  Medicare reassignment

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

{
    "created_epoch": "1563148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777248000000",
    "number": "1124670500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 WAXHAW PROFESSIONAL PARK DR STE D",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281735020",
            "telephone_number": "704-277-9009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 WAXHAW PROFESSIONAL PARK DR STE D",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281735020",
            "telephone_number": "704-277-9009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENVILLE",
        "first_name": "JENNY",
        "credential": "DHA, MA, LCMHCA, NCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-15",
        "last_updated": "2026-04-27",
        "certification_date": "2026-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NC",
            "license": "A16484",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "16481",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "A16484",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "A16484",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "SC",
            "license": "11794",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dorothy Ravenell
• Jodi Dawn Raymer, PT
• Leah Rebecca Raymond, MSW
• Tasha Regan
• Madison Joann Reis
• Resolute Care Services Inc
• Kelly Elizabeth Reyer, OTD, OTR/L
• Richard Offutt, DDS & Bobby Cockerham, DDS
• Jordan R Richards
• Troy Riley, PHARM.D

• Professional Counselor in Waxhaw, NC
• Providers in Waxhaw, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.