Healthcare Provider Details

I. General information

NPI: 1710712583
Provider Name (Legal Business Name): DANIEL JAMES LANGE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 BOULEVARD DE FRANCE BLDG 674
PARRIS ISLAND SC
29902
US

IV. Provider business mailing address

670 BOULEVARD DE FRANCE BLDG 674
PARRIS ISLAND SC
29902
US

V. Phone/Fax

Practice location:
  • Phone: 843-228-2811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberUNLICENSED
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: