Provider Demographics
NPI:1891234977
Name:LOCKE, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LOCKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:LOCKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:6801 WHITTIER AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4549
Mailing Address - Country:US
Mailing Address - Phone:703-734-0787
Mailing Address - Fax:703-734-2735
Practice Address - Street 1:6801 WHITTIER AVE STE 300
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4549
Practice Address - Country:US
Practice Address - Phone:703-734-0787
Practice Address - Fax:703-734-2735
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717000990106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist