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General NPI Number Information
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NPI Number | 1306629571
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Entity Type | Individual
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Provider Name | FELISSA LANE
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Gender | Female
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 5680 KING CENTRE DR STE 641
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City | ALEXANDRIA
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State | VA
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Zip | 22315-5757
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Country | US
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Telephone | 844-735-0222
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Fax |
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Provider Business Mailing Address
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Address Line | 542 AMHERST ST
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City | NASHUA
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State | NH
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Zip | 03063-1016
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-23-67041
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License Number State | PA
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