Healthcare Provider Details

I. General information

NPI: 1659643559
Provider Name (Legal Business Name): MARY BETH LOCKLEAR-JONES LPCS,LCAS,CCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY LOCKLEAR

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5506 PROSPECT RD
MAXTON NC
28364-7826
US

IV. Provider business mailing address

5506 PROSPECT RD
MAXTON NC
28364-7826
US

V. Phone/Fax

Practice location:
  • Phone: 910-521-0552
  • Fax:
Mailing address:
  • Phone: 910-706-1394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10796
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA9105
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9105
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: