Amanda S Sullivan, LMHCA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

A15051 Issued in NC

Practice address

2852 Wesleyan LN
Winston Salem, NC 27106-5848

Phone

(336) 926-0702

NPI assigned

Mar 18, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Evaluation and Education Services, LLC

  • Psychologist
  • Winston Salem, NC
  • NPI 1952799603
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1770169005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2852 WESLEYAN LN",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271065848",
            "telephone_number": "336-926-0702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2852 WESLEYAN LN",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271065848",
            "telephone_number": "336-926-0702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "AMANDA",
        "middle_name": "S",
        "name_prefix": "Ms.",
        "credential": "LMHCA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-18",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "A15051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "triadwellnesscounseling@gmail.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2852 Wesleyan Ln",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271065848",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Chesilin Suek, APRN, PMHNP-BC
• May-Yin Suen, RPA-C
• Norman Keith Sugg, MD
• Sara Suggs
• Taylor Sulkowski, DDS
• Andrew Sullivan
• Bridget Sullivan, ATC
• Catherine B Sullivan, FNP-C
• Christopher Albert Sullivan, MD
• Emma Sullivan, PHARMD

• Mental Health Counselor in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.