Provider Demographics
NPI:1871887562
Name:SULLIVAN, KAREN DOROTHY (PHD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:DOROTHY
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 OLD GREENSBORO RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-4817
Mailing Address - Country:US
Mailing Address - Phone:919-619-1772
Mailing Address - Fax:919-966-0083
Practice Address - Street 1:101 MANNING DR CB 7200
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-4817
Practice Address - Country:US
Practice Address - Phone:919-966-9868
Practice Address - Fax:919-966-0083
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4151103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist