Provider Demographics
NPI:1659794386
Name:LANE, ALYSSA DUGGER (BCABA)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:DUGGER
Last Name:LANE
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:PAIGE
Other - Last Name:DUGGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13000 HIGH TIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-8455
Mailing Address - Country:US
Mailing Address - Phone:434-917-3978
Mailing Address - Fax:
Practice Address - Street 1:8011 PHILIPS HWY STE 10
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7459
Practice Address - Country:US
Practice Address - Phone:434-917-3978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-13-5700103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst