MEDICARE: DEMASKING ADDICTION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1417898396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEMASKING ADDICTION

Provider Business Mailing Address
First Line	:	1169 N BURLESON BLVD STE PO
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-7011
Country	:	US
Telephone Number	:	945-536-8083
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 ALPINE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76140-4748
Country	:	US
Telephone Number	:	945-536-8083
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, OWNER
Name	:	MRS. DEMEISHA RICHE LOLLIS
Credential	:	MS, LPC-ASS., LCDC
Telephone Number	:	945-536-8083

Provider Enumeration Date	:	04/03/2026
Last Update Date	:	05/08/2026

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Directions to “DEMASKING ADDICTION ” Practice Location

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