Provider Demographics
NPI:1376742122
Name:CHILDRESS, SIERRA (MS)
Entity Type:Individual
Prefix:MRS
First Name:SIERRA
Middle Name:
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:SIERRA
Other - Middle Name:
Other - Last Name:LAHERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-5035
Mailing Address - Country:US
Mailing Address - Phone:562-218-3639
Mailing Address - Fax:562-590-8045
Practice Address - Street 1:1601 E 10TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-5035
Practice Address - Country:US
Practice Address - Phone:562-218-3639
Practice Address - Fax:562-590-8045
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor