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General NPI Number Information
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NPI Number | 1467162065
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Entity Type | Individual
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Provider Name | BENNY LOCKLEAR JR. LCSWA
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Gender | Male
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 07/01/2024
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Provider Practice Location Address
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Address Line | 432 E LONG AVE STE 2
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City | GASTONIA
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State | NC
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Zip | 28054-2540
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Country | US
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Telephone | 980-416-3025
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Fax | 980-448-3419
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Provider Business Mailing Address
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Address Line | 432 E LONG AVE STE 2
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City | GASTONIA
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State | NC
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Zip | 28054-2540
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Country | US
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Telephone | 980-416-3023
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Fax | 980-448-3419
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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 |
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License Number State |
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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 | P018517
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License Number State | NC
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