Basic Information
| Provider Information | |||||||||
| NPI: | 1669995023 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANE | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1651 SAINT PAUL ST | ||||||||
| Address2: | |||||||||
| City: | HAMPSTEAD | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210742116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4437894258 | ||||||||
| FaxNumber: | 4108485629 | ||||||||
| Practice Location | |||||||||
| Address1: | 270 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211575549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4437894258 | ||||||||
| FaxNumber: | 4108485629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LC7940 | MD | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.