Healthcare Provider Details

I. General information

NPI: 1023015864
Provider Name (Legal Business Name): JOHN M LANCASTER LPC, LSATP, CSAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 OAK AVE
BUENA VISTA VA
24416-2432
US

IV. Provider business mailing address

1844 OAK AVE
BUENA VISTA VA
24416-2432
US

V. Phone/Fax

Practice location:
  • Phone: 540-319-1014
  • Fax:
Mailing address:
  • Phone: 540-319-1014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710000717
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0718000006
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701002063
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: