Provider Demographics
NPI:1710013909
Name:LOCKLEAR, SHARON BULLARD (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:BULLARD
Last Name:LOCKLEAR
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:PO BOX 3545
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-3545
Mailing Address - Country:US
Mailing Address - Phone:910-521-4039
Mailing Address - Fax:
Practice Address - Street 1:2187 PRESTON RD
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-8697
Practice Address - Country:US
Practice Address - Phone:910-521-4039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0054451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical