Provider Demographics
NPI:1508494741
Name:LOCKLEAR, SEBRINA MICHELLE
Entity Type:Individual
Prefix:
First Name:SEBRINA
Middle Name:MICHELLE
Last Name:LOCKLEAR
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 1:380 LYNDSEY LN
Mailing Address - Street 2:
Mailing Address - City:SHANNON
Mailing Address - State:NC
Mailing Address - Zip Code:28386-9003
Mailing Address - Country:US
Mailing Address - Phone:910-374-0966
Mailing Address - Fax:
Practice Address - Street 1:380 LYNDSEY LN
Practice Address - Street 2:
Practice Address - City:SHANNON
Practice Address - State:NC
Practice Address - Zip Code:28386-9003
Practice Address - Country:US
Practice Address - Phone:910-374-0966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health