Provider Demographics
NPI:1013051044
Name:LOCKLEAR, CLYDE VANCE (LPC)
Entity type:Individual
Prefix:MR
First Name:CLYDE
Middle Name:VANCE
Last Name:LOCKLEAR
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 S MAIN ST STE I
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-4700
Mailing Address - Country:US
Mailing Address - Phone:910-277-3212
Mailing Address - Fax:910-277-3214
Practice Address - Street 1:915 S MAIN ST STE I
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-4700
Practice Address - Country:US
Practice Address - Phone:910-277-3212
Practice Address - Fax:910-277-3214
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3073101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health