Provider Demographics
NPI:1164150074
Name:WILLIAMS, SIERRA (LLC)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 SPRING GREEN BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7463
Mailing Address - Country:US
Mailing Address - Phone:804-608-5053
Mailing Address - Fax:
Practice Address - Street 1:11030 HEARTLAND GROVE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-4355
Practice Address - Country:US
Practice Address - Phone:804-608-5053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91438101YP2500X
VA0701011597103TC1900X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty