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General NPI Number Information
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NPI Number | 1518684851
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Entity Type | Individual
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Provider Name | CARRIE LANE AMFT, LAADC
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Gender | Female
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Dates
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Enumeration Date | 10/27/2022
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Last Update Date | 05/08/2024
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Provider Practice Location Address
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Address Line | 4221 WILSHIRE BLVD STE 320
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City | LOS ANGELES
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State | CA
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Zip | 90010-3559
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Country | US
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Telephone | 818-854-1221
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Fax |
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Provider Business Mailing Address
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Address Line | 23204 AETNA ST
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-3101
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Country | US
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Telephone | 818-854-1221
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LR03140124
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 144143
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License Number State | CA
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