Provider Demographics
NPI:1073649984
Name:SULLIVAN, CHRISTY (LPC, LCAS)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N. GREENSBORO ST. S
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1870
Mailing Address - Country:US
Mailing Address - Phone:919-966-9803
Mailing Address - Fax:919-966-9169
Practice Address - Street 1:410 N. GREENSBORO ST. S
Practice Address - Street 2:SUITE 220
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1870
Practice Address - Country:US
Practice Address - Phone:919-966-9803
Practice Address - Fax:919-966-9169
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4383101YM0800X
NC413101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102909Medicaid