Provider Demographics
NPI:1811585177
Name:WALL, CIERRA SHANNON (MSW LCSWA)
Entity Type:Individual
Prefix:
First Name:CIERRA
Middle Name:SHANNON
Last Name:WALL
Suffix:
Gender:F
Credentials:MSW LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7406 CHAPEL HILL RD STE J
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-5039
Mailing Address - Country:US
Mailing Address - Phone:919-986-0460
Mailing Address - Fax:919-573-0438
Practice Address - Street 1:608 W JOHNSON ST STE 5
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1242
Practice Address - Country:US
Practice Address - Phone:919-986-0460
Practice Address - Fax:919-573-0438
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0137251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical