Provider Demographics
NPI:1073882890
Name:LANCASTER, MARK LEE (LPCC, LADAC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:LEE
Last Name:LANCASTER
Suffix:
Gender:M
Credentials:LPCC, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 400 BOX 7501
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96273-0076
Mailing Address - Country:US
Mailing Address - Phone:520-303-0778
Mailing Address - Fax:
Practice Address - Street 1:PSC 400 7501
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96273-0076
Practice Address - Country:US
Practice Address - Phone:520-303-0778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0119641101YA0400X
NM0134391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health