Provider Demographics
NPI:1487209078
Name:LOCKARD, CAPRI DOMINIQUE
Entity Type:Individual
Prefix:MISS
First Name:CAPRI
Middle Name:DOMINIQUE
Last Name:LOCKARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-1615
Mailing Address - Country:US
Mailing Address - Phone:937-562-2400
Mailing Address - Fax:
Practice Address - Street 1:1095 FREDERICK DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1680
Practice Address - Country:US
Practice Address - Phone:313-550-0072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH165226171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator