Provider Demographics
NPI:1033464623
Name:SULLIVAN, ASHTON LEIGH (LPC, ATR)
Entity Type:Individual
Prefix:
First Name:ASHTON
Middle Name:LEIGH
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LPC, ATR
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 788
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-0788
Mailing Address - Country:US
Mailing Address - Phone:843-732-0850
Mailing Address - Fax:
Practice Address - Street 1:19 MARINA VILLAGE LN.
Practice Address - Street 2:UNIT 27
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-2990
Practice Address - Country:US
Practice Address - Phone:843-941-3482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6860101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional