Basic Information
| Provider Information | |||||||||
| NPI: | 1457302572 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIERRA | ||||||||
| FirstName: | CARLOS | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 322 PINE NUT LN | ||||||||
| Address2: | |||||||||
| City: | APEX | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275023716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195225536 | ||||||||
| FaxNumber: | 9198342001 | ||||||||
| Practice Location | |||||||||
| Address1: | 204 N PERSON ST | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276011047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198342000 | ||||||||
| FaxNumber: | 9198342001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2006 | ||||||||
| LastUpdateDate: | 12/30/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 4670 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 138KC | 01 | NC | BCBS INDIVIDUAL | OTHER | 6102189 | 05 | NC | MEDICAID |