Provider Demographics
NPI:1295332153
Name:KOHLER, SIERRA (LCMHCA)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:KOHLER
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 PIEDMONT AVE APT D
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-3673
Mailing Address - Country:US
Mailing Address - Phone:828-450-1423
Mailing Address - Fax:
Practice Address - Street 1:3410 HEALY DR STE 207
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1568
Practice Address - Country:US
Practice Address - Phone:336-793-7005
Practice Address - Fax:336-923-2001
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15255101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional