Organization
BARE ONES SOUL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BERNARD SULLIVAN PHD (OWNER)
(704) 813-4033
Entity
Organization
Contact information
Practice address
15411 TUXFORD DR, HUNTERSVILLE, NC 28078-3713
(704) 813-4033
Mailing address
15411 TUXFORD DR, HUNTERSVILLE, NC 28078-3713
(704) 813-4033
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6001164
—
NC
Enumeration date
08/16/2011
Last updated
10/31/2011
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