Provider Demographics
NPI:1275409013
Name:LANE, RASHEDA W
Entity type:Individual
Prefix:
First Name:RASHEDA
Middle Name:W
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 SW OBADIAH ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32331-3315
Mailing Address - Country:US
Mailing Address - Phone:850-464-8120
Mailing Address - Fax:
Practice Address - Street 1:222 SW OBADIAH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:FL
Practice Address - Zip Code:32331-3315
Practice Address - Country:US
Practice Address - Phone:850-464-8120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty