Provider Demographics
NPI:1003199852
Name:LANE, JONNIE SEAY (LCAS, LPC, CCS)
Entity Type:Individual
Prefix:
First Name:JONNIE
Middle Name:SEAY
Last Name:LANE
Suffix:
Gender:F
Credentials:LCAS, LPC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 RIDGE VIEW DR STE C
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6647
Mailing Address - Country:US
Mailing Address - Phone:252-327-3791
Mailing Address - Fax:
Practice Address - Street 1:106 RIDGE VIEW DR STE C
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6647
Practice Address - Country:US
Practice Address - Phone:252-327-3791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NC2414101YA0400X
NC9441101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)