Healthcare Provider Details

I. General information

NPI: 1316628464
Provider Name (Legal Business Name): DA'VION LANE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3070 MAPLE GROVE RD
MUSKEGON MI
49441-4080
US

IV. Provider business mailing address

7031 CORPORATE WAY STE 103
DAYTON OH
45459-4262
US

V. Phone/Fax

Practice location:
  • Phone: 231-360-5405
  • Fax: 231-360-5405
Mailing address:
  • Phone: 937-619-9089
  • Fax: 937-265-6028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451024269
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2405732-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: