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General NPI Number Information
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NPI Number | 1578894499
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Entity Type | Individual
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Provider Name | ANNA R. LANE MA, LPC, LADC
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Gender | Female
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Dates
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Enumeration Date | 01/15/2010
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Last Update Date | 12/21/2023
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Provider Practice Location Address
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Address Line | 189 STORRS RD
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City | MANSFIELD CENTER
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State | CT
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Zip | 06250-1683
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Country | US
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Telephone | 860-655-9016
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Fax |
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Provider Business Mailing Address
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Address Line | 47 MARJORIE LN
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City | MANCHESTER
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State | CT
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Zip | 06042-2076
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Country | US
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Telephone | 860-655-9016
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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 | 000575
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 001148
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License Number State | CT
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