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General NPI Number Information
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NPI Number | 1003216656
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Entity Type | Organization
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Legal Business Name | DIVERSIFIED TREATMENT SERVICES LLC
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Dates
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Enumeration Date | 09/02/2014
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Last Update Date | 09/02/2014
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Provider Practice Location Address
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Address Line | 10104 SENATE DR SUITE 228
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City | LANHAM
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State | MD
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Zip | 20706-4392
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Country | US
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Telephone | 301-577-4920
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Fax | 301-577-4940
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Provider Business Mailing Address
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Address Line | 10104 SENATE DR SUITE 228
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City | LANHAM
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State | MD
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Zip | 20706-4392
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Country | US
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Telephone | 301-577-4920
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Fax | 301-577-4940
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ALPHONSO LEWIS
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Credential |
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Telephone | 301-577-4920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC3460
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License Number State | MD
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