Healthcare Provider Details

I. General information

NPI: 1669995023
Provider Name (Legal Business Name): LAURA LANE LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 AILERON CT STE 6A
WESTMINSTER MD
21157-3012
US

IV. Provider business mailing address

1651 SAINT PAUL ST
HAMPSTEAD MD
21074-2116
US

V. Phone/Fax

Practice location:
  • Phone: 443-789-4258
  • Fax: 410-848-5629
Mailing address:
  • Phone: 443-789-4258
  • Fax: 410-848-5629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC7940
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: