Healthcare Provider Details

I. General information

NPI: 1407884752
Provider Name (Legal Business Name): DANIEL E SHOULTZ PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 GADSDEN ST., STE. 204
COLUMBIA SC
29201
US

IV. Provider business mailing address

1903 GADSDEN ST., STE. 204
COLUMBIA SC
29201
US

V. Phone/Fax

Practice location:
  • Phone: 803-254-9767
  • Fax: 803-254-9740
Mailing address:
  • Phone: 803-254-9767
  • Fax: 803-254-9740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1076
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number626
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: