Individual
SUSAN LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LMFT
Contact information
Practice address
501 N WYMORE RD, WINTER PARK, FL 32789-2808
(407) 975-2565
Mailing address
2630 HARRISON AVE, ORLANDO, FL 32804-4441
(407) 492-6433
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MFT 2121
FL
Other
Enumeration date
02/15/2007
Last updated
07/08/2007
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