Provider Demographics
NPI:1932464484
Name:LOCKLEAR, THERESA G (MSW, LCSW-P)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:G
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:MSW, LCSW-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 BARKER ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-9574
Mailing Address - Country:US
Mailing Address - Phone:910-608-1534
Mailing Address - Fax:
Practice Address - Street 1:6688 NC HIGHWAY 41 N
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2501
Practice Address - Country:US
Practice Address - Phone:910-618-9260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0060291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical