Provider Demographics
NPI:1912426297
Name:SULLIVAN SLINGERLAND, MEGAN ANN (LCMHC, NCC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ANN
Last Name:SULLIVAN SLINGERLAND
Suffix:
Gender:F
Credentials:LCMHC, NCC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ANN
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMHC, NCC
Mailing Address - Street 1:122 GATEWAY BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5544
Mailing Address - Country:US
Mailing Address - Phone:253-346-1377
Mailing Address - Fax:
Practice Address - Street 1:122 GATEWAY BLVD STE C
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5544
Practice Address - Country:US
Practice Address - Phone:253-346-1377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
NC13327101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty