Basic Information
| Provider Information | |||||||||
| NPI: | 1861674301 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOCKLEAR | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1644 MOUNT OLIVE CHURCH RD | ||||||||
| Address2: | |||||||||
| City: | LUMBERTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283608248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107390551 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2003 GODWIN AVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | LUMBERTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283583149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106711111 | ||||||||
| FaxNumber: | 9106714454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2007 | ||||||||
| LastUpdateDate: | 09/12/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 3785 | NC | N | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | 3785 | NC | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 3785 | NC | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 3785 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 6102127 | 05 | NC | MEDICAID |