Provider Demographics
NPI:1821751355
Name:WILSON, SIERRA DANYLLE (LMFT)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:DANYLLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5158
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-5158
Mailing Address - Country:US
Mailing Address - Phone:864-582-2411
Mailing Address - Fax:864-594-0040
Practice Address - Street 1:750 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-5348
Practice Address - Country:US
Practice Address - Phone:864-582-2411
Practice Address - Fax:864-594-0040
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7071106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist