Provider Demographics
NPI:1689759458
Name:NETLAND, LANCE ALFRRED (THM)
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:ALFRRED
Last Name:NETLAND
Suffix:
Gender:M
Credentials:THM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 JEFFERSON PL
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3654
Mailing Address - Country:US
Mailing Address - Phone:404-377-9730
Mailing Address - Fax:770-474-3738
Practice Address - Street 1:275 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7349
Practice Address - Country:US
Practice Address - Phone:770-474-8400
Practice Address - Fax:770-474-3738
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA334106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist