Healthcare Provider Details

I. General information

NPI: 1003216656
Provider Name (Legal Business Name): DIVERSIFIED TREATMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10104 SENATE DR SUITE 228
LANHAM MD
20706-4392
US

IV. Provider business mailing address

10104 SENATE DR SUITE 228
LANHAM MD
20706-4392
US

V. Phone/Fax

Practice location:
  • Phone: 301-577-4920
  • Fax: 301-577-4940
Mailing address:
  • Phone: 301-577-4920
  • Fax: 301-577-4940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC3460
License Number StateMD

VIII. Authorized Official

Name: ALPHONSO LEWIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 301-577-4920