Basic Information
| Provider Information | |||||||||
| NPI: | 1871887562 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SULLIVAN | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | DOROTHY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5505 OLD GREENSBORO RD | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275164817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196191772 | ||||||||
| FaxNumber: | 9199660083 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 MANNING DR CB 7200 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275994817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199669868 | ||||||||
| FaxNumber: | 9199660083 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2011 | ||||||||
| LastUpdateDate: | 08/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 4151 | NC | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.