Active NPI
Theodore W. Lane, PH.D.
- Clinical Psychologist
- Fayetteville, NC
National Provider Identifier
1023156932
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1264
- Practice address
- 1540 Purdue Dr Ste 200
Fayetteville, NC 28303-5510 - Phone
- (910) 867-8889
- Fax
- (910) 487-3061
- NPI assigned
- Feb 2, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1264 | NC | Primary |
Addresses
Primary practice location
1540 Purdue Dr Ste 200
Fayetteville, NC 28303-5510
Mailing address
1100 E Connecticut Ave
Southern Pines, NC 28387-6719
Phone (910) 692-4624
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1264 | NC | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023156932",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 E CONNECTICUT AVE",
"city": "SOUTHERN PINES",
"state": "NC",
"postal_code": "283876719",
"telephone_number": "910-692-4624"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1540 PURDUE DR STE 200",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283035510",
"telephone_number": "910-867-8889",
"fax_number": "910-487-3061"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANE",
"first_name": "THEODORE",
"middle_name": "W.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "1264",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.