Provider Demographics
NPI:1477025914
Name:LOCKLEAR, LISA FAYE (LCSWA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:FAYE
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:LCSWA
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 2844
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-2844
Mailing Address - Country:US
Mailing Address - Phone:910-751-1826
Mailing Address - Fax:
Practice Address - Street 1:609 HARRY WEST LN
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-8893
Practice Address - Country:US
Practice Address - Phone:910-521-7288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP013026101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health