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NPI Code Detail

MEDICARE: EMILY LOCKLEAR

MEDICARE:   EMILY  LOCKLEAR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker019926NC

General Provider Information

NPI Number : 1104696046
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY LOCKLEAR
Provider Business Mailing Address
First Line : 316 ALBERT RD
Second Line :
City : PEMBROKE
State : NC
Zip : 28372-9435
Country : US
Telephone Number : 910-827-1938
Fax Number :
Provider Business Practice Location Address
First Line : 900 N CHESTNUT ST
Second Line :
City : LUMBERTON
State : NC
Zip : 28358-4854
Country : US
Telephone Number : 910-739-3064
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2024
Last Update Date : 01/02/2024

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Directions to “ EMILY LOCKLEAR ” Practice Location

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