Provider Demographics
NPI:1336017060
Name:LOCKHART MORTON, ESMERALDA (SUDRC)
Entity type:Individual
Prefix:
First Name:ESMERALDA
Middle Name:
Last Name:LOCKHART MORTON
Suffix:
Gender:F
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 CALLE BIENVENIDO
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-3252
Mailing Address - Country:US
Mailing Address - Phone:619-442-0277
Mailing Address - Fax:619-442-1101
Practice Address - Street 1:1701 MISSION AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-7103
Practice Address - Country:US
Practice Address - Phone:619-442-0277
Practice Address - Fax:619-442-1101
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-24
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19957101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty