Provider Demographics
NPI:1073126090
Name:LHOTSKY SULLIVAN, COLLEEN CATHERINE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:CATHERINE
Last Name:LHOTSKY SULLIVAN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:COLLEEN
Other - Middle Name:CATHERINE
Other - Last Name:LHOTSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1170
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29484-1170
Mailing Address - Country:US
Mailing Address - Phone:843-779-7492
Mailing Address - Fax:
Practice Address - Street 1:605 1/2 WEST 5TH NORTH STREET
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483
Practice Address - Country:US
Practice Address - Phone:843-779-7492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7587101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty