MEDICARE: TASHA M LOCKLEAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CADC-32101	NC

General Provider Information

NPI Number	:	1598620213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHA M LOCKLEAR

Provider Business Mailing Address
First Line	:	7289 BURLINGTON RD
Second Line	:
City	:	WHITSETT
State	:	NC
Zip	:	27377-9785
Country	:	US
Telephone Number	:	336-604-3683
Fax Number	:

Provider Business Practice Location Address
First Line	:	7289 BURLINGTON RD TRLR 25
Second Line	:
City	:	WHITSETT
State	:	NC
Zip	:	27377-9785
Country	:	US
Telephone Number	:	336-604-3683
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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Directions to “ TASHA M LOCKLEAR ” Practice Location

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