Individual
TERESA LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW AP CP
Contact information
Practice address
1107 48TH AVE N STE 310F, MYRTLE BEACH, SC 29577-5443
(843) 457-1615
Mailing address
2919 MOSS BRIDGE LN, MYRTLE BEACH, SC 29579-3593
(843) 457-1615
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1744
SC
Other
Enumeration date
12/17/2006
Last updated
08/21/2019
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