Provider Demographics
NPI:1073982427
Name:KERSTHOLT-SULLIVAN, FRANCES (LBSW QMHP)
Entity Type:Individual
Prefix:
First Name:FRANCES
Middle Name:
Last Name:KERSTHOLT-SULLIVAN
Suffix:
Gender:F
Credentials:LBSW QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5671 N SKEEL AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:OSCODA
Mailing Address - State:MI
Mailing Address - Zip Code:48750-1535
Mailing Address - Country:US
Mailing Address - Phone:989-747-3036
Mailing Address - Fax:
Practice Address - Street 1:5671 N SKEEL AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:OSCODA
Practice Address - State:MI
Practice Address - Zip Code:48750-1535
Practice Address - Country:US
Practice Address - Phone:989-747-3036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802064622104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker