MEDICARE: INGRID LOCKLEY

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	0709025494	VA

General Provider Information

NPI Number	:	1174311997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGRID LOCKLEY

Provider Business Mailing Address
First Line	:	3412 CLUB HOUSE CT APT C
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23294-8744
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2623 PARK AVE
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-2420
Country	:	US
Telephone Number	:	804-471-4711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2025
Last Update Date	:	04/30/2025

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Directions to “ INGRID LOCKLEY ” Practice Location

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