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General NPI Number Information
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NPI Number | 1215357686
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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 | 04/23/2014
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Last Update Date | 12/10/2018
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Provider Practice Location Address
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Address Line | 1629 K ST NW SUITE 300
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City | WASHINGTON
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State | DC
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Zip | 20006-1602
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Country | US
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Telephone | 202-239-5563
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Fax |
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Provider Business Mailing Address
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Address Line | 14303 KENLON LN
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City | ACCOKEEK
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State | MD
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Zip | 20607-3745
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Country | US
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Telephone |
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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 |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PRC14152
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License Number State | DC
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