| Diversified Lifestyle Services | |
|
1300 I St Nw Suite 400e Washington DC 20005-3314 | |
| (301) 804-8279 | |
| Not Available |
| Full Name | Diversified Lifestyle Services |
|---|---|
| Speciality | Counselor |
| Location | 1300 I St Nw, Washington, District Of Columbia |
| Authorized Official Name and Position | Antoinette Lancaster (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2022395563 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Diversified Lifestyle Services 137 National Plz Suite 300 Oxon Hill MD 20745-1152 Ph: (240) 273-3191 | Diversified Lifestyle Services 1300 I St Nw Suite 400e Washington DC 20005-3314 Ph: (301) 804-8279 |
| NPI Number | 1205213527 |
|---|---|
| Provider Enumeration Date | 05/06/2015 |
| Last Update Date | 12/10/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205213527 | NPI | - | NPPES |
| 755104500 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | PRC14152 (District Of Columbia) | Primary |
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | CACII1131 (District Of Columbia) | Secondary |
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