Provider Demographics
NPI:1043469661
Name:LOCKLEAR, JILL ALICE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:ALICE
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1934 BONNER ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-4105
Mailing Address - Country:US
Mailing Address - Phone:440-935-0843
Mailing Address - Fax:
Practice Address - Street 1:10 PARK PLACE SOUTH SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-2913
Practice Address - Country:US
Practice Address - Phone:404-616-6257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012934103TC0700X
GALPC005850101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical