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General NPI Number Information
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NPI Number | 1346891975
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Entity Type | Individual
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Provider Name | RAUL ANTHONY DELACRUZ-LANE PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/25/2019
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 1310 24TH AVE S
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City | NASHVILLE
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State | TN
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Zip | 37212-2637
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Country | US
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Telephone | 615-873-6938
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Fax |
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Provider Business Mailing Address
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Address Line | 122 BEECH FORGE DR
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City | ANTIOCH
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State | TN
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Zip | 37013-2326
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Country | US
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Telephone | 615-693-1950
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CTB-2024-0255
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CTB-2024-0151
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License Number State | NM
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