Provider Information for 1619663564
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CLARISSA LANE LCSW
Sex: Female
NPI: 1619663564
Last Updated: 2024-05-21
Certification Date: 2024-05-21
Certification Date: 2024-05-21
Details
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NPI | 1619663564 | ||||||||
Enumeration Date | 2023-04-13 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | YES | ||||||||
Status | Active | ||||||||
Mailing Address | 11839 VETERANS MEMORIAL HWY FORT BLACKMORE, VA 24250-2676 United States Phone: 276-248-8199 | Fax: | ||||||||
Primary Practice Address | 11839 VETERANS MEMORIAL HWY FORT BLACKMORE, VA 24250-2676 United States Phone: 276-248-8199 | Fax: | ||||||||
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