Provider Demographics
NPI:1093304719
Name:LOCKLEAR, MELISSA MARIE (LCSWA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 LACY ST # 2224
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5341
Mailing Address - Country:US
Mailing Address - Phone:336-270-9562
Mailing Address - Fax:336-585-7522
Practice Address - Street 1:10441 PARLIAMENT AVE
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-2476
Practice Address - Country:US
Practice Address - Phone:910-706-7812
Practice Address - Fax:336-585-7522
Is Sole Proprietor?:No
Enumeration Date:2021-01-16
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0151761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP015176OtherLICENSE