Provider Demographics
NPI:1013568161
Name:LOCKLEAR, ANGELA RENA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENA
Last Name:LOCKLEAR
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 1:8650 ARABIA RD
Mailing Address - Street 2:
Mailing Address - City:LUMBER BRIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28357-9603
Mailing Address - Country:US
Mailing Address - Phone:910-257-5005
Mailing Address - Fax:
Practice Address - Street 1:402 HARRIS AVE
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-3112
Practice Address - Country:US
Practice Address - Phone:910-875-5590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0138541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical