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General NPI Number Information
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NPI Number | 1205358009
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Entity Type | Individual
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Provider Name | ANNIE FORBES LANE
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Gender | Female
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Dates
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Enumeration Date | 07/13/2017
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Last Update Date | 05/13/2022
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Provider Practice Location Address
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Address Line | 902 GALLIA ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-4139
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Country | US
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Telephone | 740-529-2125
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 396
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City | SPRINGBORO
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State | OH
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Zip | 45066-0396
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | BP00942485
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.1903661
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License Number State | OH
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