Provider Demographics
NPI:1336330117
Name:LANE, HEAVEN FRANKIE (LCPC-C)
Entity Type:Individual
Prefix:MRS
First Name:HEAVEN
Middle Name:FRANKIE
Last Name:LANE
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 BICKFORD TER
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04493-4460
Mailing Address - Country:US
Mailing Address - Phone:207-732-5276
Mailing Address - Fax:
Practice Address - Street 1:40 SUMMER ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6446
Practice Address - Country:US
Practice Address - Phone:207-947-0366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME104100000X
MEXL3614101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker