Individual
MS. BREONNA DELOIS LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1634 PLEXOR LN, KNIGHTDALE, NC 27545-7285
(910) 315-9479
Mailing address
1634 PLEXOR LN, KNIGHTDALE, NC 27545-7285
(910) 315-9479
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C015558
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477189546
—
NC
Enumeration date
03/20/2020
Last updated
10/26/2023
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