Provider Demographics
NPI:1417649054
Name:LOCKLEAR, MARISSA (LCAS-A)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:LOCKLEAR
Suffix:
Gender:
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3203 PERSIMMON RD
Mailing Address - Street 2:
Mailing Address - City:ROWLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28383-6745
Mailing Address - Country:US
Mailing Address - Phone:910-501-9939
Mailing Address - Fax:
Practice Address - Street 1:805 HARLEYSVILLE RD
Practice Address - Street 2:
Practice Address - City:ROWLAND
Practice Address - State:NC
Practice Address - Zip Code:28383-8179
Practice Address - Country:US
Practice Address - Phone:910-501-9939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-301911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical