| Doctor Name: | MS. WANDALYN LANE |
| NPI Number: | 1003941915 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA |
| License Number: | |
| Business Practice Address: | 1585 S D St 101 San Bernardino, CA - 924083257 |
| Business Phone Number: | 9093882222 |
| Business Fax Number: | 9093882220 |
| Mailing Address: | 1501 Hughes Way, LONG BEACH |
| State: | CA |
| Postal Code: | 908101876 |
| Phone Number: | 3102216336 |
| Fax Number: | |
| NPI Enumeration Date: | 02/22/2007 |
| NPI Last Update Date: | 01/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |