MEDICARE: MRS. REGINA M LANE LCAS, CCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	521	NC

General Provider Information

NPI Number	:	1932378171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REGINA M LANE LCAS, CCS

Provider Business Mailing Address
First Line	:	500 NASH MEDICAL ARTS MALL
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-1417
Country	:	US
Telephone Number	:	252-937-8141
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 NASH MEDICAL ARTS MALL
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-1417
Country	:	US
Telephone Number	:	252-937-8141
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2008
Last Update Date	:	02/21/2008

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