Provider Demographics
NPI:1962050245
Name:NEAL, SIERRA LA TYCE (CRC, LCAS-A)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:LA TYCE
Last Name:NEAL
Suffix:
Gender:F
Credentials:CRC, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4913 ARBOR CHASE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-6567
Mailing Address - Country:US
Mailing Address - Phone:336-830-7607
Mailing Address - Fax:
Practice Address - Street 1:8376 SIX FORKS RD STE 104
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5095
Practice Address - Country:US
Practice Address - Phone:919-900-7438
Practice Address - Fax:919-900-7576
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24612101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)