Provider Demographics
NPI:1215176789
Name:LOCKARD, KERI MARIE
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:MARIE
Last Name:LOCKARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:MARIE
Other - Last Name:PONCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7200 SKYWAY
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-3280
Mailing Address - Country:US
Mailing Address - Phone:530-877-1965
Mailing Address - Fax:530-872-7784
Practice Address - Street 1:7200 SKYWAY
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-3280
Practice Address - Country:US
Practice Address - Phone:530-877-1965
Practice Address - Fax:530-872-7784
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW613601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical