Provider Demographics
NPI:1356496822
Name:ULLERUP, SAUNDRA S (LPC)
Entity Type:Individual
Prefix:
First Name:SAUNDRA
Middle Name:S
Last Name:ULLERUP
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 WOODFIN PL STE 114
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2468
Mailing Address - Country:US
Mailing Address - Phone:828-253-0643
Mailing Address - Fax:828-253-7766
Practice Address - Street 1:70 WOODFIN PL STE 114
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2468
Practice Address - Country:US
Practice Address - Phone:828-253-0643
Practice Address - Fax:828-253-7766
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3097101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102200Medicaid
NC12963OtherBCBS