Provider Demographics
NPI:1477837052
Name:LANE, VICTORIA ASHLEY
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ASHLEY
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 CEDARWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-3027
Mailing Address - Country:US
Mailing Address - Phone:530-966-0133
Mailing Address - Fax:
Practice Address - Street 1:3095 INDEPENDENCE DR
Practice Address - Street 2:BUILDING B SUITE A
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-7629
Practice Address - Country:US
Practice Address - Phone:925-443-3434
Practice Address - Fax:925-443-9384
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor