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Individual

LISA MARIE LOCKLEAR

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
305 E 3RD ST, PEMBROKE, NC 28372-7991
(910) 521-7461
Mailing address
PO BOX 3043, PEMBROKE, NC 28372-3043
(910) 852-0929
(910) 521-7463

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
22428
NC

Other

Enumeration date
10/05/2017
Last updated
10/05/2017
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