Provider Demographics
NPI:1154780906
Name:LOCKETT, RENA VINCENT (LCSW-A)
Entity type:Individual
Prefix:MRS
First Name:RENA
Middle Name:VINCENT
Last Name:LOCKETT
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 GRANTLAND DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-3464
Mailing Address - Country:US
Mailing Address - Phone:919-923-8612
Mailing Address - Fax:
Practice Address - Street 1:505 GRANTLAND DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-3464
Practice Address - Country:US
Practice Address - Phone:919-923-8612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0099811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical