=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053439281
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTOPHER HOWARD LANE PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8308 OLD COURTHOUSE RD STE B
-----------------------------------------------------
City | VIENNA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22182-3863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-556-4140
-----------------------------------------------------
Fax | 703-893-2837
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8308 OLD COURTHOUSE RD STE B
-----------------------------------------------------
City | VIENNA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22182-3863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-556-4140
-----------------------------------------------------
Fax | 703-893-2837
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 0107001619
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------