| Theodore W. Lane Phd, Pllc | |
|
185 E New Hampshire Ave Southern Pines NC 28387-5529 | |
| (910) 692-9100 | |
| (910) 692-9109 |
| Full Name | Theodore W. Lane Phd, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 185 E New Hampshire Ave, Southern Pines, North Carolina |
| Authorized Official Name and Position | Theodore W Lane (SOLE MEMBER) |
| Authorized Official Contact | 9106929100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Theodore W. Lane Phd, Pllc 185 E New Hampshire Ave Southern Pines NC 28387-5529 Ph: (910) 692-9100 | Theodore W. Lane Phd, Pllc 185 E New Hampshire Ave Southern Pines NC 28387-5529 Ph: (910) 692-9100 |
| NPI Number | 1427412360 |
|---|---|
| Provider Enumeration Date | 04/06/2016 |
| Last Update Date | 04/06/2016 |
| Medicare PECOS PAC ID | 8820396765 |
|---|---|
| Medicare Enrollment ID | O20160411000791 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427412360 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 1264 (North Carolina) | Primary |
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