Healthcare Provider Details

I. General information

NPI: 1659846541
Provider Name (Legal Business Name): CASSAUNDRA PAIGE LOCKLEAR MA, NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 LYNNHAVEN PKWY STE 350
VIRGINIA BEACH VA
23452-7350
US

IV. Provider business mailing address

575 LYNNHAVEN PKWY STE 305
VIRGINIA BEACH VA
23452-7350
US

V. Phone/Fax

Practice location:
  • Phone: 804-207-6737
  • Fax: 757-257-9120
Mailing address:
  • Phone: 804-207-6737
  • Fax: 757-257-9120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA14241
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701014852
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: