Provider Demographics
NPI:1477051076
Name:LOCKE, KATHERINE S (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:S
Last Name:LOCKE
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 1:4900 TOPPING LN
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-2405
Mailing Address - Country:US
Mailing Address - Phone:804-338-9015
Mailing Address - Fax:
Practice Address - Street 1:4110 E PARHAM RD STE 208
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-2754
Practice Address - Country:US
Practice Address - Phone:804-562-6527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040101951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical