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General NPI Number Information
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NPI Number | 1144776808
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Entity Type | Individual
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Provider Name | CAROLINE LOCKETT-CORWELL LMFT, APCC, CADC II
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Gender | Female
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 02/06/2020
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Provider Practice Location Address
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Address Line | 11600 SANTA ROSA RD
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City | SANTA ROSA VALLEY
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State | CA
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Zip | 93012-8208
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Country | US
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Telephone | 415-404-9223
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Fax |
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Provider Business Mailing Address
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Address Line | 1573 VAN EPPS ST SE
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City | ATLANTA
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State | GA
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Zip | 30316-2117
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Country | US
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Telephone | 404-889-1801
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1022
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4351
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 113833
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License Number State | CA
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