Individual
JENNIFER B LOCKLEAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NCC, LPCS, LCAS, CSI
Contact information
Practice address
6620 SHALLOWFORD RD, SUITE 200, LEWISVILLE, NC 27023-9504
(336) 757-0258
(336) 945-0342
Mailing address
6620 SHALLOWFORD RD, SUITE 200, LEWISVILLE, NC 27023-9504
(336) 757-0258
(336) 945-0342
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
5123
NC
101YM0800X
Mental Health Counselor
5123
NC
101YP2500X
Professional Counselor
Primary
5123
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1780013037
GROUP NPI
NC
05
—
6103500
—
NC
Enumeration date
09/28/2006
Last updated
11/18/2014
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