Provider Demographics
NPI:1851842694
Name:BULL CITY PSYCHOTHERAPY, PLLC
Entity Type:Organization
Organization Name:BULL CITY PSYCHOTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:DORTON
Authorized Official - Last Name:CAUDLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC-S
Authorized Official - Phone:919-698-7061
Mailing Address - Street 1:1816 FRONT ST STE 250
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2598
Mailing Address - Country:US
Mailing Address - Phone:919-382-0288
Mailing Address - Fax:
Practice Address - Street 1:1816 FRONT ST STE 250
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2598
Practice Address - Country:US
Practice Address - Phone:919-382-0288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3539101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty