Provider Demographics
NPI:1215609441
Name:LOCKETT, ANNIE NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:NICOLE
Last Name:LOCKETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 MAYLAND DR STE S
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4648
Mailing Address - Country:US
Mailing Address - Phone:276-285-0151
Mailing Address - Fax:
Practice Address - Street 1:1807 E CHURCH STREET EXT
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-3143
Practice Address - Country:US
Practice Address - Phone:276-285-0151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1253611041C0700X
NCC0142201041C0700X
VA09040125471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical