Provider Demographics
NPI:1720100738
Name:LANCASTER, DARREL WAYNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DARREL
Middle Name:WAYNE
Last Name:LANCASTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6911 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-2111
Mailing Address - Country:US
Mailing Address - Phone:662-893-7135
Mailing Address - Fax:662-893-7078
Practice Address - Street 1:6911 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-2111
Practice Address - Country:US
Practice Address - Phone:662-893-7135
Practice Address - Fax:662-893-7078
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS297103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist