Provider Demographics
NPI:1962299412
Name:CARLOCK, PHOEBE GRACE
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:GRACE
Last Name:CARLOCK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:PHOEBE
Other - Middle Name:GRACE
Other - Last Name:JOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2568 ROUTE 109
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:ME
Mailing Address - Zip Code:04001-5839
Mailing Address - Country:US
Mailing Address - Phone:207-604-3197
Mailing Address - Fax:
Practice Address - Street 1:2568 ROUTE 109
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:ME
Practice Address - Zip Code:04001-5839
Practice Address - Country:US
Practice Address - Phone:207-604-3197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program