Healthcare Provider Details

I. General information

NPI: 1043178379
Provider Name (Legal Business Name): BREONNA LOCKETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 POLK ST
WINNSBORO LA
71295-2346
US

IV. Provider business mailing address

608 POLK ST
WINNSBORO LA
71295-2346
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-1300
  • Fax: 318-323-1400
Mailing address:
  • Phone: 318-323-1300
  • Fax: 318-323-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: