Provider Demographics
NPI:1013259522
Name:LOCKLEAR, MARTIN L (MA)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:L
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2932 UNION SCHOOL ROAD
Mailing Address - Street 2:
Mailing Address - City:ROWLAND
Mailing Address - State:NORTH CAROLINA
Mailing Address - Zip Code:28383
Mailing Address - Country:UM
Mailing Address - Phone:910-374-7270
Mailing Address - Fax:
Practice Address - Street 1:523 ROCKINGHAM RD
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-3615
Practice Address - Country:US
Practice Address - Phone:910-562-9882
Practice Address - Fax:910-562-9955
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10039101YP2500X
NC299004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNAOtherNA