Provider Demographics
NPI:1932378171
Name:LANE, REGINA M (LCAS, CCS)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:M
Last Name:LANE
Suffix:
Gender:F
Credentials:LCAS, CCS
Other - Prefix:MRS
Other - First Name:GINA
Other - Middle Name:M
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCAS, CCS
Mailing Address - Street 1:500 NASH MEDICAL ARTS MALL
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1417
Mailing Address - Country:US
Mailing Address - Phone:252-937-8141
Mailing Address - Fax:
Practice Address - Street 1:500 NASH MEDICAL ARTS MALL
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-1417
Practice Address - Country:US
Practice Address - Phone:252-937-8141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC521101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)