Provider Demographics
NPI:1457502049
Name:LANE, LINDA LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LEE
Last Name:LANE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:425 CUMBERLAND ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1909
Mailing Address - Country:US
Mailing Address - Phone:423-698-0802
Mailing Address - Fax:
Practice Address - Street 1:425 CUMBERLAND ST
Practice Address - Street 2:SUITE 110
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1909
Practice Address - Country:US
Practice Address - Phone:423-698-0802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0025861041C0700X
TNLSW00000035171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNLSW0000003517OtherPACE