Provider Demographics
NPI:1730721002
Name:SULLIVAN, SARAH (LCMHC, NCC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LCMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 GATEWAY BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5544
Mailing Address - Country:US
Mailing Address - Phone:704-360-3637
Mailing Address - Fax:704-200-9829
Practice Address - Street 1:10430 HARRIS OAK BLVD STE L
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-7513
Practice Address - Country:US
Practice Address - Phone:704-360-3637
Practice Address - Fax:704-200-9829
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15274101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health