Individual
MS. JESSICA RAQUEL LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCMHCA
Contact information
Practice address
607 WICKER ST, SANFORD, NC 27330-4151
(910) 658-5394
Mailing address
607 WICKER ST, SANFORD, NC 27330-4151
(910) 658-5394
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
A17479
NC
Other
Enumeration date
06/25/2022
Last updated
06/25/2022
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