MEDICARE: SIERRA THOMAS LCMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	A17053	NC

General Provider Information

NPI Number	:	1881472421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIERRA THOMAS LCMHC

Provider Business Mailing Address
First Line	:	78 CULLEN CT
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27520-6228
Country	:	US
Telephone Number	:	919-763-6583
Fax Number	:

Provider Business Practice Location Address
First Line	:	4805 GREEN RD STE 103
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-2848
Country	:	US
Telephone Number	:	919-872-6220
Fax Number	:	919-872-6223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2023
Last Update Date	:	09/15/2023

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