MEDICARE: MS. ANDREA LASHON LANE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	4472	AL
2	101YP2500X	Professional Counselor	4472	AL

General Provider Information

NPI Number	:	1366069486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA LASHON LANE

Provider Business Mailing Address
First Line	:	1911 GRAND RESERVE DR
Second Line	:
City	:	PELHAM
State	:	AL
Zip	:	35124-1271
Country	:	US
Telephone Number	:	334-462-8399
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 19TH ST N STE 201
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-3219
Country	:	US
Telephone Number	:	334-462-8399
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2020
Last Update Date	:	02/24/2024

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