Provider Demographics
NPI:1336016674
Name:LOCKLEAR, STEFANIE ELENA
Entity type:Individual
Prefix:MISS
First Name:STEFANIE
Middle Name:ELENA
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4912 RED HILL RD
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-7756
Mailing Address - Country:US
Mailing Address - Phone:910-720-1101
Mailing Address - Fax:910-720-1083
Practice Address - Street 1:4912 RED HILL RD
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-7756
Practice Address - Country:US
Practice Address - Phone:910-720-1101
Practice Address - Fax:910-720-1083
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2075-14854-01175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist