Provider Demographics
NPI:1013221662
Name:DAVIS-LANE, GINA L (MSW, LCADC, CCS)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:L
Last Name:DAVIS-LANE
Suffix:
Gender:F
Credentials:MSW, LCADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2521
Mailing Address - Country:US
Mailing Address - Phone:732-897-7701
Mailing Address - Fax:732-897-7705
Practice Address - Street 1:238 NEPTUNE BLVD
Practice Address - Street 2:2B
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-8600
Practice Address - Country:US
Practice Address - Phone:732-897-7701
Practice Address - Fax:732-897-7705
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ200031501101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)