Provider Demographics
NPI:1538738919
Name:LOCK, CHARLOTTE ANN (MA, LPCC, LADC)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:ANN
Last Name:LOCK
Suffix:
Gender:F
Credentials:MA, LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-2572
Mailing Address - Country:US
Mailing Address - Phone:812-267-8656
Mailing Address - Fax:
Practice Address - Street 1:821 W SAINT GERMAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-3536
Practice Address - Country:US
Practice Address - Phone:320-259-5381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306052101YA0400X
MNCC04367101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)