Individual
MS. JACQUELINE ELIZABETH LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
304 KEMPER ST, TIMMONSVILLE, SC 29161-1922
(843) 346-3956
(843) 346-5159
Mailing address
304 KEMPER ST, TIMMONSVILLE, SC 29161-1922
(843) 346-3956
(843) 346-5159
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
4616
SC
Other
Enumeration date
08/07/2013
Last updated
08/07/2013
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