Provider Demographics
NPI:1902402324
Name:SIERRA, MARIANGELLY (LCMHC)
Entity Type:Individual
Prefix:
First Name:MARIANGELLY
Middle Name:
Last Name:SIERRA
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5348 S SUGAR RD APT 1202
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-0196
Mailing Address - Country:US
Mailing Address - Phone:939-244-3996
Mailing Address - Fax:
Practice Address - Street 1:311 NEW BERN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-1417
Practice Address - Country:US
Practice Address - Phone:919-836-3747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14843101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health