Provider Demographics
NPI:1649490145
Name:LANCASTER, CAROLYN FRANCES
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:FRANCES
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3862 POTOMAC AVE
Mailing Address - Street 2:8
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-1624
Mailing Address - Country:US
Mailing Address - Phone:323-299-8525
Mailing Address - Fax:
Practice Address - Street 1:4041 MARLTON AVE
Practice Address - Street 2:136
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-2519
Practice Address - Country:US
Practice Address - Phone:323-294-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAS REGISTION #4800101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)