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Individual
MR. JEREMY LANE
Active
Individual
MR. JEREMY LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, CADC-II
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
ASW72258
CA
101YA0400X
Addiction (Substance Use Disorder) Counselor
RA8390716
CA
1041C0700X
Clinical Social Worker
Primary
LCSW87637
CA
Other
Enumeration date
07/27/2016
Last updated
03/26/2019
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