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General NPI Number Information
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NPI Number | 1205213527
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Entity Type | Organization
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Legal Business Name | DIVERSIFIED LIFESTYLE SERVICES
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Dates
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Enumeration Date | 05/06/2015
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Last Update Date | 12/10/2018
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Provider Practice Location Address
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Address Line | 1300 I ST NW SUITE 400E
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City | WASHINGTON
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State | DC
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Zip | 20005-3314
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Country | US
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Telephone | 301-804-8279
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Fax |
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Provider Business Mailing Address
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Address Line | 137 NATIONAL PLZ SUITE 300
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City | OXON HILL
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State | MD
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Zip | 20745-1152
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Country | US
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Telephone | 240-273-3191
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. ANTOINETTE LANCASTER
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Credential | LPC, LCPC, NCC, MAC
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Telephone | 202-239-5563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CACII1131
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | PRC14152
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License Number State | DC
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