=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659761583
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAMEKA LANCASTER, LCSW, LADAC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2015
-----------------------------------------------------
Last Update Date | 02/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 650 S SHACKLEFORD RD SUITE 400-MM
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72211-3522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-251-8330
-----------------------------------------------------
Fax | 501-246-8484
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 650 S SHACKLEFORD RD SUITE 400-MM
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72211-3522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-251-8330
-----------------------------------------------------
Fax | 501-246-8484
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOCIAL WORKER
-----------------------------------------------------
Name | MS. TAMEKA LANCASTER
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 501-251-8330
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------