Provider Demographics
NPI:1326221441
Name:SUNRISE CLINICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:SUNRISE CLINICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANYA
Authorized Official - Middle Name:ONUOHA
Authorized Official - Last Name:ODIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-493-5013
Mailing Address - Street 1:3500 WESTGATE DR
Mailing Address - Street 2:SUITE 604
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2567
Mailing Address - Country:US
Mailing Address - Phone:919-493-5013
Mailing Address - Fax:919-493-5026
Practice Address - Street 1:3500 WESTGATE DR
Practice Address - Street 2:SUITE 604
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2567
Practice Address - Country:US
Practice Address - Phone:919-493-5013
Practice Address - Fax:919-493-5026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2596103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty