Healthcare Provider Details

I. General information

NPI: 1790858470
Provider Name (Legal Business Name): WILLIAM HUGH LANE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3578 S FULTON AVE
HAPEVILLE GA
30354-1756
US

IV. Provider business mailing address

3578 S FULTON AVE
HAPEVILLE GA
30354-1756
US

V. Phone/Fax

Practice location:
  • Phone: 404-669-3462
  • Fax: 404-669-3957
Mailing address:
  • Phone: 404-669-3462
  • Fax: 404-669-3957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number002434
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: