| Diversified Lifestyle Services | |
|
137 National Plz Suite 300 Oxon Hill MD 20745-1152 | |
| (301) 804-8279 | |
| (240) 204-8153 |
| Full Name | Diversified Lifestyle Services |
|---|---|
| Speciality | Counselor - Professional |
| Location | 137 National Plz, Oxon Hill, Maryland |
| 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 14303 Kenlon Ln Accokeek MD 20607-3745 Ph: (301) 804-8279 | Diversified Lifestyle Services 137 National Plz Suite 300 Oxon Hill MD 20745-1152 Ph: (301) 804-8279 |
| NPI Number | 1881001857 |
|---|---|
| Provider Enumeration Date | 07/22/2014 |
| Last Update Date | 12/10/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881001857 | NPI | - | NPPES |
| 755104500 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LC5764 (Maryland) | Primary |
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