Provider Demographics
NPI:1891066908
Name:LANE, W. PATRICK (DD)
Entity Type:Individual
Prefix:DR
First Name:W.
Middle Name:PATRICK
Last Name:LANE
Suffix:
Gender:M
Credentials:DD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 RIFLE RANGE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3935
Mailing Address - Country:US
Mailing Address - Phone:843-819-5533
Mailing Address - Fax:
Practice Address - Street 1:1519 RIFLE RANGE RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3935
Practice Address - Country:US
Practice Address - Phone:843-819-5533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI8995101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral