Provider Demographics
NPI:1427728963
Name:SLADE, SIERRA (MA, LCAS-A)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:SLADE
Suffix:
Gender:F
Credentials:MA, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 MAHALA DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-3455
Mailing Address - Country:US
Mailing Address - Phone:919-949-8003
Mailing Address - Fax:
Practice Address - Street 1:129 MAYO ST
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-2573
Practice Address - Country:US
Practice Address - Phone:919-643-1739
Practice Address - Fax:919-643-0902
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-24265101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)