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NPI Code Detail

MEDICARE: TARA LANE LPC

MEDICARE: TARA LANE LPC
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
1101YM0800XMental Health Counselor7332SC
2101YM0800XMental Health Counselor
3101YP2500XProfessional Counselor7332SC

General Provider Information

NPI Number : 1952795445
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA LANE LPC
Provider Business Mailing Address
First Line : 2513 DANIEL ISLAND DR
Second Line :
City : DANIEL ISLAND
State : SC
Zip : 29492-8904
Country : US
Telephone Number : 609-412-8789
Fax Number :
Provider Business Practice Location Address
First Line : 710 JOHNNIE DODDS BLVD STE 200
Second Line :
City : MOUNT PLEASANT
State : SC
Zip : 29464-3045
Country : US
Telephone Number : 843-800-1303
Fax Number : 888-316-7716
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2015
Last Update Date : 05/07/2025

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Directions to “ TARA LANE LPC” Practice Location

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