Provider Demographics
NPI:1306647417
Name:LOCKYER-BRATTON, MARY (LGPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:LOCKYER-BRATTON
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:AMMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:262 MADDEX FARM DR
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25443-4344
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:124 N COURT ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6614
Practice Address - Country:US
Practice Address - Phone:301-304-7108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP16134101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health