Provider Demographics
NPI:1952421364
Name:LANE, STEPHANIE D (LBSW, MS)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:LANE
Suffix:
Gender:F
Credentials:LBSW, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHSIDE
Mailing Address - State:AL
Mailing Address - Zip Code:35907-7620
Mailing Address - Country:US
Mailing Address - Phone:256-413-7871
Mailing Address - Fax:
Practice Address - Street 1:109 S 8TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-3601
Practice Address - Country:US
Practice Address - Phone:256-547-6311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3467B1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical