Provider Demographics
NPI:1134466311
Name:LOCKLEAR, MELISSA A (LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:LOCKLEAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:691 COY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAULS
Mailing Address - State:NC
Mailing Address - Zip Code:28384
Mailing Address - Country:US
Mailing Address - Phone:910-316-6627
Mailing Address - Fax:
Practice Address - Street 1:1101 ARSENAL AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5331
Practice Address - Country:US
Practice Address - Phone:910-316-6627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP007084104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker