MEDICARE: SARAH LOCKLEAR MSW, LCSW-A

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	1041C0700X	Clinical Social Worker
2	1041C0700X	Clinical Social Worker	P016446	NC

General Provider Information

NPI Number	:	1790367290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH LOCKLEAR MSW, LCSW-A

Provider Business Mailing Address
First Line	:	122 W 4TH AVE
Second Line	:
City	:	RED SPRINGS
State	:	NC
Zip	:	28377-1508
Country	:	US
Telephone Number	:	910-876-5410
Fax Number	:

Provider Business Practice Location Address
First Line	:	2411 N ELM ST
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28358-3658
Country	:	US
Telephone Number	:	910-802-4365
Fax Number	:	910-802-4581

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

Provider Enumeration Date	:	04/23/2021
Last Update Date	:	07/05/2021

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