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General NPI Number Information
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NPI Number | 1255814125
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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 | 09/07/2018
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Last Update Date | 12/10/2018
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Provider Practice Location Address
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Address Line | 2255 CRAIN HWY STE 102
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City | WALDORF
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State | MD
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Zip | 20601-3186
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Country | US
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Telephone | 301-804-8279
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Fax | 240-204-8153
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Provider Business Mailing Address
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Address Line | 137 NATIONAL PLAZA SUITE 300
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City | NATIONAL HARBOR
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State | MD
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Zip | 20745
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Country | US
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Telephone | 301-804-8279
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Fax | 240-204-8153
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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 | EDD, 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 |
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License Number State |
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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 |
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License Number State |
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