Provider Demographics
NPI:1346591161
Name:LOCKMAN, JOEY DOUGLAS (LCAS)
Entity Type:Individual
Prefix:MR
First Name:JOEY
Middle Name:DOUGLAS
Last Name:LOCKMAN
Suffix:
Gender:M
Credentials:LCAS
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 370
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28053-0370
Mailing Address - Country:US
Mailing Address - Phone:704-862-6663
Mailing Address - Fax:704-869-7336
Practice Address - Street 1:325 N MARIETTA ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-2331
Practice Address - Country:US
Practice Address - Phone:704-862-6663
Practice Address - Fax:704-869-7336
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1030101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)