Healthcare Provider Details

I. General information

NPI: 1881123792
Provider Name (Legal Business Name): HEATHER LYNN LOCKEY LCSW, LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER LOCKEY ENGLEHART HEATHER GUTHRIE

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 12/28/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5509 CREEDMOOR RD
RALEIGH NC
27612-6312
US

IV. Provider business mailing address

5509 CREEDMOOR RD
RALEIGH NC
27612-6312
US

V. Phone/Fax

Practice location:
  • Phone: 919-523-6520
  • Fax:
Mailing address:
  • Phone: 919-573-6520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP011514
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC012291
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: