Individual
SHANNON J. LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHRT-CSP
Contact information
Practice address
127 PALMER ST, CALAIS, ME 04619-1300
(207) 454-0270
(207) 454-0232
Mailing address
180 ACADEMY ST STE 3, PRESQUE ISLE, ME 04769-3183
(207) 554-2352
(207) 554-2351
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103850000
MAINE CARE
—
Enumeration date
10/27/2011
Last updated
02/02/2021
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