Provider Demographics
NPI:1295134054
Name:SPELLMON, SIERRA NICOLE (LCSWA, LCASA)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:NICOLE
Last Name:SPELLMON
Suffix:
Gender:F
Credentials:LCSWA, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 GROUNDWATER PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1476
Mailing Address - Country:US
Mailing Address - Phone:252-327-7879
Mailing Address - Fax:
Practice Address - Street 1:1306 PADDOCK DR STE E100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4873
Practice Address - Country:US
Practice Address - Phone:919-790-2446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0091611041C0700X
NCLCAS-20199101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)