Provider Demographics
NPI:1700239142
Name:LOCKLEAR, KRISTY L (LCSWA)
Entity Type:Individual
Prefix:MISS
First Name:KRISTY
Middle Name:L
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 1:506 SANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-8504
Mailing Address - Country:US
Mailing Address - Phone:910-734-4422
Mailing Address - Fax:
Practice Address - Street 1:506 SANDERSON RD
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-8504
Practice Address - Country:US
Practice Address - Phone:910-734-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP010461101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health