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General NPI Number Information
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NPI Number | 1649589425
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Entity Type | Organization
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Legal Business Name | SIERRA'S RESIDENTIAL SERVICES, INC.
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Dates
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Enumeration Date | 09/28/2010
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Last Update Date | 09/30/2010
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Provider Practice Location Address
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Address Line | 1995 US 421 N
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City | LILLINGTON
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State | NC
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Zip | 27546-7436
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Country | US
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Telephone | 910-814-4243
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Fax | 910-814-4245
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Provider Business Mailing Address
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Address Line | PO BOX 655
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City | LILLINGTON
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State | NC
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Zip | 27546-0655
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Country | US
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Telephone | 910-814-4243
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Fax | 910-814-4245
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. SCOTTIE JEFFERY VANHOOK
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Credential | MSW, LCSW
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Telephone | 910-814-4243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | C002092
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | C002092
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License Number State | NC
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