Individual
MISS IDA DAVIS LOCKETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M. ED, LPC, NCC
Contact information
Practice address
5721 EMPRESS DR, MOBILE, AL 36609-3308
(251) 554-7068
Mailing address
5721 EMPRESS DR, MOBILE, AL 36609-3308
(251) 554-7068
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
804
AL
Other
Enumeration date
05/31/2022
Last updated
05/31/2022
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