Healthcare Provider Details

I. General information

NPI: 1831901032
Provider Name (Legal Business Name): YOLANDA LANE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 SERENE LAKE DR
GRIFFIN GA
30223-8209
US

IV. Provider business mailing address

1015 SERENE LAKE DR
GRIFFIN GA
30223-8209
US

V. Phone/Fax

Practice location:
  • Phone: 404-750-5602
  • Fax:
Mailing address:
  • Phone: 404-750-5602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC015300
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: