Provider Information for 1861932501
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JACQUELYN GOLDEN-LANE LMSW
Sex: Female
NPI: 1861932501
Last Updated: 2017-03-14
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1861932501 | ||||||||
| Enumeration Date | 2017-02-28 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 6549 TOWN CENTER DR SUITE A CLARKSTON, MI 48346-4824 United States Phone: 248-620-6400 | Fax:248-620-6405 | ||||||||
| Primary Practice Address | 32961 MIDDLEBELT RD FARMINGTON HILLS, MI 48334-1773 United States Phone: 248-855-1540 | Fax:248-855-2481 | ||||||||
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| Health Information Exchange |
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