Individual
MS. JILL ALICE LOCKLEAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC
Contact information
Practice address
10 PARK PLACE SOUTH SE, ATLANTA, GA 30303-2913
(404) 616-6257
Mailing address
1934 BONNER ST, DECATUR, GA 30032-4105
(440) 935-0843
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC005850
GA
103TC0700X
Clinical Psychologist
6301012934
MI
Other
Enumeration date
09/18/2008
Last updated
08/06/2012
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