Provider Demographics
NPI:1588055693
Name:TANNER, SIERRA DALYSE
Entity type:Individual
Prefix:MS
First Name:SIERRA
Middle Name:DALYSE
Last Name:TANNER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SIERRA
Other - Middle Name:DALYSE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17825 HALTON PARK DR
Mailing Address - Street 2:APT 2C
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-0698
Mailing Address - Country:US
Mailing Address - Phone:304-921-4523
Mailing Address - Fax:
Practice Address - Street 1:17825 HALTON PARK DR
Practice Address - Street 2:APT 2C
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-0698
Practice Address - Country:US
Practice Address - Phone:304-921-4523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor