Individual
MARY L LOCKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, NCC
Contact information
Practice address
445 WINN WAY, DECATUR, GA 30030-1707
(470) 508-6439
Mailing address
1509 STONE GATE LN SE, ATLANTA, GA 30317-2056
(912) 656-0059
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
GA
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
GA
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
03/20/2020
Last updated
03/20/2020
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