Provider Demographics
NPI:1164095386
Name:LANE, AIMEE MICHELLE (LCMHCA)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:MICHELLE
Last Name:LANE
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 CROWN CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-7803
Mailing Address - Country:US
Mailing Address - Phone:704-849-4011
Mailing Address - Fax:704-845-1611
Practice Address - Street 1:2124 CROWN CENTRE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-7803
Practice Address - Country:US
Practice Address - Phone:706-987-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-24
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16776101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health