Provider Demographics
NPI:1669995023
Name:LANE, LAURA (LCPC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 SAINT PAUL ST
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-2116
Mailing Address - Country:US
Mailing Address - Phone:443-789-4258
Mailing Address - Fax:410-848-5629
Practice Address - Street 1:90 AILERON CT STE 6A
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-3012
Practice Address - Country:US
Practice Address - Phone:443-789-4258
Practice Address - Fax:410-848-5629
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7940101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional