Provider Demographics
NPI:1942891668
Name:LANE, KRISTIAN (LCMHC-A, NCC)
Entity Type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:LCMHC-A, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4802 BUTTONBUSH DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-8941
Mailing Address - Country:US
Mailing Address - Phone:919-627-2191
Mailing Address - Fax:
Practice Address - Street 1:4802 BUTTONBUSH DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27712-8941
Practice Address - Country:US
Practice Address - Phone:919-627-2191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health