Healthcare Provider Details

I. General information

NPI: 1346891975
Provider Name (Legal Business Name): RAUL ANTHONY DELACRUZ-LANE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RAUL ANTHONY DELACRUZ PH.D.

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 24TH AVE S
NASHVILLE TN
37212-2637
US

IV. Provider business mailing address

122 BEECH FORGE DR
ANTIOCH TN
37013-2326
US

V. Phone/Fax

Practice location:
  • Phone: 615-873-6938
  • Fax:
Mailing address:
  • Phone: 615-693-1950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2024-0151
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2024-0255
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: