Provider Demographics
NPI:1518684851
Name:LANE, CARRIE (AMFT, LAADC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:AMFT, LAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23204 AETNA ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-3101
Mailing Address - Country:US
Mailing Address - Phone:818-854-1221
Mailing Address - Fax:
Practice Address - Street 1:4221 WILSHIRE BLVD STE 320
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3559
Practice Address - Country:US
Practice Address - Phone:818-854-1221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALR03140124101YA0400X
CA144143106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)