Provider Demographics
NPI:1932325289
Name:LANE, WILLIAM DAVID (PHD)
Entity Type:Individual
Prefix:PROF
First Name:WILLIAM
Middle Name:DAVID
Last Name:LANE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 EASTBROOK BND
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1530
Mailing Address - Country:US
Mailing Address - Phone:770-716-1444
Mailing Address - Fax:678-669-2693
Practice Address - Street 1:14 EASTBROOK BND
Practice Address - Street 2:SUITE 201
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1530
Practice Address - Country:US
Practice Address - Phone:770-716-1444
Practice Address - Fax:678-669-2693
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001745101YP2500X
GAMFT000754106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA7045899OtherAETNA
GA52205944OtherBCBS
GALPC001745OtherPROFESSIONAL COUNSELOR
GAMFT000754OtherMARRAIGE & FAMILY THERAP