Individual
DR. BERNARD HARRELL SULLIVAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
203 N HOFFMAN ST, DALLAS, NC 28034-1525
(704) 813-4033
Mailing address
203 N HOFFMAN ST, DALLAS, NC 28034-1525
(704) 813-4033
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
102806
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1817W
BCBS NC
NC
05
—
6001164
—
NC
Enumeration date
04/30/2009
Last updated
01/14/2019
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