Provider Demographics
NPI:1144776808
Name:LOCKETT-CORWELL, CAROLINE (LMFT, APCC, CADC II)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:
Last Name:LOCKETT-CORWELL
Suffix:
Gender:F
Credentials:LMFT, APCC, CADC II
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:CORWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT, APCC, CADC II
Mailing Address - Street 1:1573 VAN EPPS ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-2117
Mailing Address - Country:US
Mailing Address - Phone:404-889-1801
Mailing Address - Fax:
Practice Address - Street 1:11600 SANTA ROSA RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93012-8208
Practice Address - Country:US
Practice Address - Phone:415-404-9223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1022101YA0400X
CA4351101YP2500X
CA113833106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional