DIVERSIFIED LIFESTYLE SERVICES (NPI# 1255814125) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255814125 |
| Entity Type | Organization |
| Organization Name | DIVERSIFIED LIFESTYLE SERVICES |
| Practice Address |
2255 Crain Hwy Ste 102 Waldorf MD 20601-3186 |
| Mailing Address |
137 National Plaza Suite 300 National Harbor MD 20745 |
| Practice Telephone | 3018048279 |
| Practice Fax Number | 2402048153 |
| Mailing Telephone | 3018048279 |
| Mailing Fax Number | 2402048153 |
| Enumeration Date | 2018-09-07 |
| Last Update Date | 2018-12-10 |
| Authorized Official Name | DR. ANTOINETTE LANCASTER (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 2022395563 |
| Authorized Official Credential | EDD, LCPC, NCC, |
| Is Organization Subpart | Y |
| Parent Organization Name | LANCASTER, FRAZIER, AND ASSOCIATES, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| Other Name | Type Code |
|---|---|
| Diversified Lifestyle Services | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619448149 | Diversified Lifestyle Services | Counselor | 6710 Oxon Hill Rd Ste 10, Oxon Hill, MD 20745-1117 | 2018-12-10 |
| 1881001857 | Diversified Lifestyle Services | Counselor | 137 National Plz, Suite 300, Oxon Hill, MD 20745-1152 | 2014-07-22 |
| 1205213527 | Diversified Lifestyle Services | Counselor | 1300 I St Nw, Suite 400e, Washington, DC 20005-3314 | 2015-05-06 |
| 1215357686 | Diversified Lifestyle Services | Counselor | 1629 K St Nw, Suite 300, Washington, DC 20006-1602 | 2014-04-23 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | DIVERSIFIED LIFESTYLE SERVICES | 6710 Oxon Hill Rd Ste 210, Oxon Hill, MD 20745-1124 |
| Street Address |
2255 CRAIN HWY STE 102 |
| City | WALDORF |
| State | MD |
| Zip Code | 20601-3186 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609321637 | Kierra Jordan | Counselor | 2255 Crain Hwy Ste 102, Waldorf, MD 20601 | 2016-08-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154960128 | Sarian Beverly Wilson | Nurse Practitioner | 2203 Kayhill Dr, Waldorf, MD 20601 | 2019-12-23 |
| 1447778055 | Macy Alexandra Forman | Pharmacist | 3061 Tecnology Place, Waldorf, MD 20601 | 2017-09-04 |
| 1922523919 | Gregoire Mcclain | Counselor | Pathways Inc 2670 Crain Hwy, Suite 409, Waldorf, MD 20601 | 2017-08-10 |
| 1477091866 | Lutisse Cooper | Home Health Aide | 2520 Breakwater Court, Waldorf, MD 20601 | 2017-02-06 |
| 1215286828 | Linda Kline-lau | Counselor | 2255 Crain Highway, Waldorf, MD 20601 | 2012-08-29 |
| 1205124609 | Marian E. Kirk | Physical Therapist | 2960 Technology Place, Suite 110, Waldorf, MD 20601 | 2011-07-19 |
| 1932345238 | Patient First Maryland Medical Group | Non-Pharmacy Dispensing Site | 2855 Crain Highway, Waldorf, MD 20601 | 2008-12-17 |
| 1720150741 | Marianna Jeanne Patente | Counselor | 2670 Crain Highway, Suite #401, Waldorf, MD 20601 | 2006-11-14 |
| 1407940968 | Harold J. Pincus | Dentist | 2955 Crain Hwy., Waldorf, MD 20601 | 2006-10-02 |
| 1073610127 | Asthma Allergy and Sinus Center, LLC | Clinic/Center | 3600 Leonardtown Road, Suite 103, Waldorf, MD 20601 | 2006-09-20 |
| Find all providers in zip 20601 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588279897 | Mary Chinedu Mpi | Counselor | 2187 Forman Ct, Waldorf, MD 20601-5607 | 2020-09-14 |
| 1043833874 | Anthony Bernard Pinkney | Counselor | 3408 Williamsburg Dr, Waldorf, MD 20601-3011 | 2020-05-27 |
| 1497390058 | Bailey, Cross & Davis LLC | Counselor | 2670 Crain Hwy Ste 510, Waldorf, MD 20601-2819 | 2019-11-07 |
| 1578124178 | Baltimore Area Community Health Services LLC | Counselor | 2255 Crain Hwy Ste 106, Waldorf, MD 20601-3186 | 2019-06-25 |
| 1275198475 | H.o.p.e Behavioral Health | Counselor | 3261 Old Washington Rd Ste 3021, Waldorf, MD 20602-3229 | 2019-05-03 |
| 1053801159 | Yameeka Bailey | Counselor | 4227 Quigley Ct, Waldorf, MD 20602-1520 | 2018-05-14 |
| 1831699693 | Lacole A Cole | Counselor | 3195 Old Washington Rd Ste 110, Waldorf, MD 20602-3201 | 2018-02-19 |
| 1386150167 | Project Chesapeake, LLC | Counselor | 21 Industrial Park Dr Ste 104d, Waldorf, MD 20602-2751 | 2017-12-16 |
| 1972028710 | Maria Cocoros | Counselor | 3200 Crain Hwy Ste 203, Waldorf, MD 20603-4841 | 2017-08-12 |
| 1942722970 | Ron C Johnson | Counselor | 11680 Doolittle Dr Ste 103, Waldorf, MD 20602-3802 | 2017-07-11 |
| Find all providers in WALDORF | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.