Healthcare Provider Details

I. General information

NPI: 1174435879
Provider Name (Legal Business Name): FAITH MARIE LOCKLEAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2492 OHARA DR
RAEFORD NC
28376-6564
US

IV. Provider business mailing address

2492 OHARA DR
RAEFORD NC
28376-6564
US

V. Phone/Fax

Practice location:
  • Phone: 910-510-8104
  • Fax: 910-510-8104
Mailing address:
  • Phone: 910-510-8104
  • Fax: 910-510-8104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: