Individual
THEODORE W. LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1540 PURDUE DR STE 200, FAYETTEVILLE, NC 28303-5510
(910) 867-8889
(910) 487-3061
Mailing address
1100 E CONNECTICUT AVE, SOUTHERN PINES, NC 28387-6719
(910) 692-4624
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1264
NC
Other
Enumeration date
02/02/2007
Last updated
07/08/2007
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