Healthcare Provider Details

I. General information

NPI: 1770640765
Provider Name (Legal Business Name): MARKLANE, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 PATTERSON AVE SUITE G-102
RICHMOND VA
23229-6430
US

IV. Provider business mailing address

8401 PATTERSON AVE SUITE G-102
RICHMOND VA
23229-6430
US

V. Phone/Fax

Practice location:
  • Phone: 804-740-1829
  • Fax:
Mailing address:
  • Phone: 804-740-1829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number0701002355
License Number StateVA

VIII. Authorized Official

Name: MARK RICHARD LANE
Title or Position: PRESIDENT
Credential: D.MIN.
Phone: 804-740-1829