Healthcare Provider Details

I. General information

NPI: 1952724205
Provider Name (Legal Business Name): LANTERN THERAPEUTIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11680 DOOLITTLE DR SUITE 111
WALDORF MD
20602-3801
US

IV. Provider business mailing address

1282 SMALLWOOD DR W SUITE 507
WALDORF MD
20603-4732
US

V. Phone/Fax

Practice location:
  • Phone: 240-607-2756
  • Fax: 240-607-2776
Mailing address:
  • Phone: 240-607-2756
  • Fax: 240-607-2776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. KAREN JONES
Title or Position: CLINICAL DIRECTOR/ CEO
Credential: LCPC
Phone: 240-607-2756