Provider Demographics
NPI:1679097067
Name:GILES, SIERRA (BCABA)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:GILES
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BARRINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-5639
Mailing Address - Country:US
Mailing Address - Phone:912-658-0037
Mailing Address - Fax:
Practice Address - Street 1:29 PLANTATION PARK DR STE 204
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-9008
Practice Address - Country:US
Practice Address - Phone:843-706-0831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst