Marissa Lane

NPI #1538981956 in Ladson, South Carolina

Provider Information

NPI Number: 1538981956
Entity Type: Individual
Name: Marissa Lane
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Behavior Technician
Enumeration Date: Oct 28, 2024
Last Updated: Oct 28, 2024

Practice Location

Address: 482 OLD FORT DR
City: Ladson
State: South Carolina
ZIP Code: 29456-5277
Phone: (843) 996-2350

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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