Provider Demographics
NPI:1770710733
Name:LOCKLEAR, BRENDA MOORE (LCAS)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:MOORE
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2590
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-2590
Mailing Address - Country:US
Mailing Address - Phone:910-521-2900
Mailing Address - Fax:910-272-1650
Practice Address - Street 1:402 N PINE ST
Practice Address - Street 2:SUITE D
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-5584
Practice Address - Country:US
Practice Address - Phone:910-738-2110
Practice Address - Fax:910-738-2988
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1422101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)