Provider Demographics
NPI:1871872622
Name:LOCKETT, GERINDA (LPC)
Entity type:Individual
Prefix:
First Name:GERINDA
Middle Name:
Last Name:LOCKETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3665 CLUB DR
Mailing Address - Street 2:STE 107
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1806
Mailing Address - Country:US
Mailing Address - Phone:678-288-6550
Mailing Address - Fax:800-609-0965
Practice Address - Street 1:3040 RIVERSIDE DR
Practice Address - Street 2:STE D-5
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2521
Practice Address - Country:US
Practice Address - Phone:478-757-4800
Practice Address - Fax:478-757-4888
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005950101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional