Healthcare Provider Details

I. General information

NPI: 1417240854
Provider Name (Legal Business Name): SIERRA'S RESIDENTIAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 US 421 N
LILLINGTON NC
27546-7436
US

IV. Provider business mailing address

PO BOX 655
LILLINGTON NC
27546-0655
US

V. Phone/Fax

Practice location:
  • Phone: 910-814-4243
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOTTIE VANHOOK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 910-257-1156