Provider Demographics
NPI:1568178564
Name:LANE, CHELSEA DEANE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:CHELSEA
Middle Name:DEANE
Last Name:LANE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 LEADMINE RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PINE
Mailing Address - State:TN
Mailing Address - Zip Code:37890-4204
Mailing Address - Country:US
Mailing Address - Phone:423-312-7561
Mailing Address - Fax:
Practice Address - Street 1:1500 PINNACLES WAY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-7308
Practice Address - Country:US
Practice Address - Phone:866-461-4474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13162104100000X
TN14584104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker