Healthcare Provider Details

I. General information

NPI: 1003729542
Provider Name (Legal Business Name): HUGH TULLNER III LCMHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8376 SIX FORKS RD STE 104
RALEIGH NC
27615-5095
US

IV. Provider business mailing address

5020 DAWN PIPER DR
RALEIGH NC
27613-5660
US

V. Phone/Fax

Practice location:
  • Phone: 919-585-5085
  • Fax:
Mailing address:
  • Phone: 919-665-8037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23486
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: