Provider Demographics
NPI:1962729871
Name:ANNA R. LANE MA, LPC, LADC, LLC
Entity type:Organization
Organization Name:ANNA R. LANE MA, LPC, LADC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LADC
Authorized Official - Phone:860-655-9016
Mailing Address - Street 1:384 MERROW RD STE D
Mailing Address - Street 2:TWIN PONDS CENTER
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-3957
Mailing Address - Country:US
Mailing Address - Phone:860-655-9016
Mailing Address - Fax:
Practice Address - Street 1:384 MERROW RD STE P
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3970
Practice Address - Country:US
Practice Address - Phone:860-655-9016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-02
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000575101YA0400X
CT001148101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty