Healthcare Provider Details

I. General information

NPI: 1942891668
Provider Name (Legal Business Name): KRISTIAN LANE LCMHC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 BUTTONBUSH DR
DURHAM NC
27712-8941
US

IV. Provider business mailing address

4802 BUTTONBUSH DR
DURHAM NC
27712-8941
US

V. Phone/Fax

Practice location:
  • Phone: 919-627-2191
  • Fax:
Mailing address:
  • Phone: 919-627-2191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11677
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: