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General NPI Number Information
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NPI Number | 1750523395
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Entity Type | Individual
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Provider Name | COLLEEN LORRAINE CAMPBELL-LANE PHD, LCSW, ACHP-SW
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Gender | Female
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Dates
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Enumeration Date | 03/27/2009
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 115 4TH AVE SE STE 309
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City | ABERDEEN
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State | SD
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Zip | 57401-4360
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Country | US
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Telephone | 703-346-8361
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Fax |
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Provider Business Mailing Address
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Address Line | 10342 BARRINGTON CT
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City | LEESBURG
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State | FL
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Zip | 34788-3545
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Country | US
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Telephone | 703-346-8361
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW8754
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License Number State | FL
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