Individual
WANDA LYNN LAINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CAP
Contact information
Practice address
650 SUFFOLK ST, LOWELL, MA 01854-3642
(978) 452-5155
Mailing address
10 RADCLIFFE DR, HUDSON, NH 03051-4743
(603) 305-4048
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CAP100114
FL
Other
Enumeration date
01/16/2018
Last updated
01/16/2018
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