Provider Demographics
NPI:1669597886
Name:LANCASTER, STEPHEN ROY (MA LLPC,QMRP)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ROY
Last Name:LANCASTER
Suffix:
Gender:M
Credentials:MA LLPC,QMRP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1110 ELDON BAKER DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1923
Mailing Address - Country:US
Mailing Address - Phone:810-280-9512
Mailing Address - Fax:810-280-9512
Practice Address - Street 1:1110 ELDON BAKER DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1923
Practice Address - Country:US
Practice Address - Phone:810-280-9512
Practice Address - Fax:810-280-9512
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014572101YM0800X
MI6803786341104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1669597886OtherNPI