Provider Demographics
NPI:1457302572
Name:SIERRA, CARLOS R (LPC)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:R
Last Name:SIERRA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 PINE NUT LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-3716
Mailing Address - Country:US
Mailing Address - Phone:919-522-5536
Mailing Address - Fax:919-834-2001
Practice Address - Street 1:204 N PERSON ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-1047
Practice Address - Country:US
Practice Address - Phone:919-834-2000
Practice Address - Fax:919-834-2001
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4670101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC138KCOtherBCBS INDIVIDUAL
NC6102189Medicaid