Active NPI
Bryan E. Sullivan, LPC
- Mental Health Counselor
- Charlotte, NC
National Provider Identifier
1710006325
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LPC3531
- Practice address
- 1123 S Church St
Charlotte, NC 28203-4003 - Phone
- (704) 370-3235
- Fax
- (704) 370-3377
- NPI assigned
- Mar 28, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LPC3531 | NC | Primary |
Addresses
Primary practice location
1123 S Church St
Charlotte, NC 28203-4003
Mailing address
1123 S Church St
Charlotte, NC 28203-4003
Phone (704) 370-3235
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6102012 | Medicaid | NC | |
| E0997 | Other | NC | MEDCOST |
| 1378C | Other | NC | BLUECROSS BLUESHIELD |
| 358073 | Other | NC | MHN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC3531 | NC | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Catholic Charities Diocese of Charlotee | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710006325",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1123 S CHURCH ST",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282034003",
"telephone_number": "704-370-3235",
"fax_number": "704-370-3377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1123 S CHURCH ST",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282034003",
"telephone_number": "704-370-3235",
"fax_number": "704-370-3377"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "BRYAN",
"middle_name": "E.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "LPC3531",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6102012",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST",
"identifier": "E0997",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS BLUESHIELD",
"identifier": "1378C",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHN",
"identifier": "358073",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.