Provider Demographics
NPI:1467712463
Name:LOCKHART, TRIBIA FRYE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TRIBIA
Middle Name:FRYE
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 3RD ST NW APT 4C
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-3903
Mailing Address - Country:US
Mailing Address - Phone:601-695-0151
Mailing Address - Fax:
Practice Address - Street 1:619 3RD ST NW
Practice Address - Street 2:
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111-3903
Practice Address - Country:US
Practice Address - Phone:601-695-0151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC68021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical