Active NPI
Renee Anne Lake, PH.D.
- School Psychologist
- Mount Pleasant, SC
National Provider Identifier
1629643283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 4708
- Practice address
- 3003 Dunes West Blvd Ste 3
Mount Pleasant, SC 29466-8001 - Phone
- (843) 352-4060
- NPI assigned
- May 25, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 4708 | SC | Primary |
Addresses
Primary practice location
3003 Dunes West Blvd Ste 3
Mount Pleasant, SC 29466-8001
Mailing address
2655 Park West Blvd
Mount Pleasant, SC 29466-7246
Phone (315) 521-3166
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4708 | SC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621900800000",
"number": "1629643283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2655 PARK WEST BLVD",
"city": "MOUNT PLEASANT",
"state": "SC",
"postal_code": "294667246",
"telephone_number": "315-521-3166"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3003 DUNES WEST BLVD STE 3",
"city": "MOUNT PLEASANT",
"state": "SC",
"postal_code": "294668001",
"telephone_number": "843-352-4060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAKE",
"first_name": "RENEE",
"middle_name": "ANNE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-05-25",
"last_updated": "2021-05-25",
"certification_date": "2021-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist, School",
"state": "SC",
"license": "4708",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Pleasant, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.