Provider Demographics
NPI:1104824143
Name:LOCKE-DOWNER, LISA M (PHD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:LOCKE-DOWNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-0028
Mailing Address - Country:US
Mailing Address - Phone:434-466-1588
Mailing Address - Fax:434-823-1174
Practice Address - Street 1:300 CLAREMONT LN STE 103
Practice Address - Street 2:
Practice Address - City:CROZET
Practice Address - State:VA
Practice Address - Zip Code:22932-3455
Practice Address - Country:US
Practice Address - Phone:434-466-1588
Practice Address - Fax:866-289-5249
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003340103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0810003340OtherSTATE LICENSING BOARD
VAQ44954AMedicare PIN