Provider Demographics
NPI:1437643673
Name:LOCKLEAR, RACHEL (LISW-CP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2049 LAKEBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-5820
Mailing Address - Country:US
Mailing Address - Phone:407-330-8761
Mailing Address - Fax:
Practice Address - Street 1:108 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-1549
Practice Address - Country:US
Practice Address - Phone:407-330-8761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC124401041C0700X
FLSW147881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical