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General NPI Number Information
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NPI Number | 1215609441
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Entity Type | Individual
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Provider Name | ANNIE NICOLE LOCKETT LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 07/15/2024
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Provider Practice Location Address
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Address Line | 1807 E CHURCH STREET EXT
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City | MARTINSVILLE
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State | VA
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Zip | 24112-3143
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Country | US
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Telephone | 276-285-0151
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Fax |
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Provider Business Mailing Address
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Address Line | 8401 MAYLAND DR STE S
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City | RICHMOND
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State | VA
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Zip | 23294-4648
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Country | US
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Telephone | 276-285-0151
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 125361
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C014220
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904012547
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License Number State | VA
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