Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 0701002355 | VA |
NPI | 1164518882 |
---|---|
Provider Name | Mark Richard Lane |
First Address | Richmond, VA 23221 |
Second Address | Richmond, VA 23221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 24/10/2007 |