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General NPI Number Information
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NPI Number | 1669724365
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Entity Type | Organization
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Legal Business Name | SULLIVAN & ASSOCIATES LLC
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Dates
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Enumeration Date | 10/05/2012
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 3225 W SUGAR CREEK RD
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City | CHARLOTTE
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State | NC
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Zip | 28269-7314
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Country | US
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Telephone | 704-813-4033
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Fax | 888-251-0617
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Provider Business Mailing Address
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Address Line | 3225 W SUGAR CREEK RD
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City | CHARLOTTE
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State | NC
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Zip | 28269-7314
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | BERNARD SULLIVAN JR.
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Credential | PHD
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Telephone | 704-813-4033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number | 102806
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 102806
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 102806
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License Number State | NC
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