Provider Demographics
NPI:1346891975
Name:DELACRUZ-LANE, RAUL ANTHONY (PHD)
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:ANTHONY
Last Name:DELACRUZ-LANE
Suffix:
Gender:
Credentials:PHD
Other - Prefix:DR
Other - First Name:RAUL
Other - Middle Name:ANTHONY
Other - Last Name:DELACRUZ-LANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:122 BEECH FORGE DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-2326
Mailing Address - Country:US
Mailing Address - Phone:615-693-1950
Mailing Address - Fax:
Practice Address - Street 1:1310 24TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2637
Practice Address - Country:US
Practice Address - Phone:615-873-6938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2024-0255101YM0800X
103T00000X
NMCTB-2024-0151101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist