Healthcare Provider Details

I. General information

NPI: 1982274049
Provider Name (Legal Business Name): ADRIA SULLIVAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S SALEM ST STE 424
APEX NC
27502-1863
US

IV. Provider business mailing address

5329 MAPLECHASE LN
APEX NC
27539-4163
US

V. Phone/Fax

Practice location:
  • Phone: 317-504-1852
  • Fax:
Mailing address:
  • Phone: 317-504-1852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1902030521
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerINDIVIDUAL NPI

VIII. Authorized Official

Name: ADRIA SULLIVAN
Title or Position: PRESIDENT
Credential: LCMHC
Phone: 317-504-1852