Provider Demographics
NPI:1023040177
Name:SULAK, ANDREA L (MA, LLP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:L
Last Name:SULAK
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:MACFARLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28000 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-2468
Mailing Address - Country:US
Mailing Address - Phone:586-753-0405
Mailing Address - Fax:586-753-0404
Practice Address - Street 1:17250 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3151
Practice Address - Country:US
Practice Address - Phone:734-425-4070
Practice Address - Fax:734-425-8350
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011137103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist