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General NPI Number Information
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NPI Number | 1629708409
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Entity Type | Individual
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Provider Name | JAY WESLEY LANE
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Gender | Male
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Dates
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Enumeration Date | 06/14/2022
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 9351 W BROAD ST
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City | HENRICO
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State | VA
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Zip | 23294-5437
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Country | US
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Telephone | 804-352-6232
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Fax |
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Provider Business Mailing Address
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Address Line | 411 BAINBRIDGE ST APT 152
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City | RICHMOND
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State | VA
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Zip | 23224-2388
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Country | US
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Telephone | 804-489-7327
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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 |
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License Number State |
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