Provider Demographics
NPI:1982274049
Name:ADRIA SULLIVAN PC
Entity Type:Organization
Organization Name:ADRIA SULLIVAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:317-504-1852
Mailing Address - Street 1:5329 MAPLECHASE LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-4163
Mailing Address - Country:US
Mailing Address - Phone:317-504-1852
Mailing Address - Fax:
Practice Address - Street 1:315 S SALEM ST STE 424
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-1863
Practice Address - Country:US
Practice Address - Phone:317-504-1852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1902030521OtherINDIVIDUAL NPI