Provider Demographics
NPI:1053976779
Name:SULLIVAN, KATHERINE (LPCA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRC
Mailing Address - Street 1:201 S ELLIOTT RD APT 243
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-5967
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 S ELLIOTT RD APT 243
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-5967
Practice Address - Country:US
Practice Address - Phone:704-995-6631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14576101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health