| NPI | 1659643559 |
|---|---|
| Former Name | MARY LOCKLEAR |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC A9105) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health (Licence: NC 9105) | |
| Enumeration Date | 2012-02-08 |
| Last Update Date | 2021-11-05 |