JENNA STAUB LCSW-A, LCAS-A
NPI 1629673835
Counselor - Addiction (Substance Use Disorder) in Wilmington, NC

Q: What is Jenna Staub's NPI number?

The NPI number for Jenna Staub is 1629673835. It was assigned to this individual provider in the NPPES registry on December 3, 2020.

Q: What is Jenna Staub's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

Q: When was this NPI record last updated?

The NPPES record for Jenna Staub was last updated on April 13, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since December 03, 2020PECOS Enrolled

503 COVIL AVE STE 102, WILMINGTON, NC 28403(910) 995-4154 Get Directions Write a Review

NPPES record last updated: April 13, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Apr 13, 2024, Dec 3, 2020 (2 updates tracked since 2020).

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About Jenna Staub Lcsw-a, Lcas-a NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JENNA STAUB LCSW-A, LCAS-A (NPI 1629673835) is an individual addiction (substance use disorder) provider in Wilmington, North Carolina, licensed in North Carolina (29080) and active in the NPI registry since December 2020. She is enrolled in Medicare PECOS, maintains a secondary practice location in Raleigh, and is a graduate of Other (2023).

NPPES Registry Identity

NPI1629673835

Entity TypeIndividualFemale

Primary Taxonomy101YA0400X

Provider Legal NameJENNA STAUBCredential: LCSW-A, LCAS-A

Location Address503 COVIL AVE STE 102Wilmington, NC 28403-2683

Mailing Address421 Fayetteville St Ste 1100Raleigh, NC 27601-3000 · (877) 418-2978 · Fax (866) 500-2186

Phone(910) 995-4154

Sole ProprietorNo

Medical School CMSOtherGraduated 2023

Enumeration DateDecember 3, 2020

Last NPPES UpdateApril 13, 20242 updates tracked since enumeration

NPPES CertifiedApril 13, 2024

✔ NPI 1629673835 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers

Taxonomy Code101YA0400X

License✔ Licensed in NC · 29080

Also ListedBehavior TechnicianTaxonomy 106S00000X

503 COVIL AVE STE 102, Wilmington, NC 28403

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Secondary Practice Location 1

Location 1421 Fayetteville St Ste 1100Raleigh, NC 27601-3000 · Phone (877) 418-2978 · Fax (866) 500-2186

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jenna Staub Lcsw-a, Lcas-a is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID2365919024

PECOS Enrollment IDI20260430000756

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KYLE KWIATKOWSKI

Behavior Technician