Provider Demographics
NPI:1275024911
Name:LOCKLEAR, TARA BLUE (LCSW-A)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:BLUE
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:JO
Other - Last Name:BLUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2003 GODWIN AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3149
Mailing Address - Country:US
Mailing Address - Phone:910-739-8849
Mailing Address - Fax:910-739-8698
Practice Address - Street 1:2003 GODWIN AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3149
Practice Address - Country:US
Practice Address - Phone:910-739-8849
Practice Address - Fax:910-739-8698
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPO169171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical