Individual
BRENDA LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3810-3 WILLIAMSBURG PARK BLVD, JACKSONVILLE, FL 32257-9220
(904) 419-6102
(904) 739-2153
Mailing address
3810-3 WILLIAMSBURG PARK BLVD, JACKSONVILLE, FL 32257-9220
(904) 419-6102
(904) 739-2153
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH 3602
FL
Other
Enumeration date
08/28/2014
Last updated
08/28/2014
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