Provider Demographics
NPI:1457633752
Name:SULLIVAN, AMANDA ALLIEN VIVIAN (LCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ALLIEN VIVIAN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:POLZIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 TECHNOLOGY DR STE A
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-5009
Mailing Address - Country:US
Mailing Address - Phone:919-445-7020
Mailing Address - Fax:919-445-2352
Practice Address - Street 1:100 TECHNOLOGY DR STE A
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-5009
Practice Address - Country:US
Practice Address - Phone:828-251-6319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1191851041C0700X
390200000X
NCC0117791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program