Provider Demographics
NPI:1871352864
Name:LOCKLAIR, ALEXIS LIVENGOOD (MS, LCMHCA)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:LIVENGOOD
Last Name:LOCKLAIR
Suffix:
Gender:F
Credentials:MS, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 OLEANDER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-0800
Mailing Address - Country:US
Mailing Address - Phone:910-508-9449
Mailing Address - Fax:
Practice Address - Street 1:3208 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-0800
Practice Address - Country:US
Practice Address - Phone:910-794-3929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18558101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health