Provider Demographics
NPI:1043942675
Name:MARLEY, JALEA LASHAE (LCSW-A)
Entity type:Individual
Prefix:
First Name:JALEA
Middle Name:LASHAE
Last Name:MARLEY
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 N THIRD ST
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-2112
Mailing Address - Country:US
Mailing Address - Phone:336-257-2795
Mailing Address - Fax:
Practice Address - Street 1:1013 BULLARD CT STE 102
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6801
Practice Address - Country:US
Practice Address - Phone:919-583-7910
Practice Address - Fax:919-278-2647
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1077391Medicaid
NC1041C0700XMedicaid