Provider Demographics
NPI:1952795445
Name:LANE, TARA (LPC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:GODINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2513 DANIEL ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8904
Mailing Address - Country:US
Mailing Address - Phone:609-412-8789
Mailing Address - Fax:
Practice Address - Street 1:710 JOHNNIE DODDS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3045
Practice Address - Country:US
Practice Address - Phone:843-800-1303
Practice Address - Fax:888-316-7716
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
SC7332101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health