Provider Demographics
NPI:1467996157
Name:VANCE, LANE ALEXANDER (LPC)
Entity Type:Individual
Prefix:MR
First Name:LANE
Middle Name:ALEXANDER
Last Name:VANCE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:946 BUSHWICK AVE APT D2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-3765
Mailing Address - Country:US
Mailing Address - Phone:917-887-2096
Mailing Address - Fax:
Practice Address - Street 1:946 BUSHWICK AVE APT D2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-3765
Practice Address - Country:US
Practice Address - Phone:917-887-2096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-14
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005562101Y00000X
GALPC010993101YP2500X
NY010210101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional