Provider Demographics
NPI:1871762369
Name:SULFRIDGE, DANIEL BRIAN (LPCC)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:BRIAN
Last Name:SULFRIDGE
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 523
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40476-0523
Mailing Address - Country:US
Mailing Address - Phone:859-488-1096
Mailing Address - Fax:
Practice Address - Street 1:311 GERI LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2305
Practice Address - Country:US
Practice Address - Phone:859-488-1096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY104603101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30610026Medicaid
KY7100430190Medicaid