Provider Demographics
NPI:1083350490
Name:SULLIVAN, SARA C (MS)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:C
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8275 MAJORS GLEN CT
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9309
Mailing Address - Country:US
Mailing Address - Phone:404-519-3356
Mailing Address - Fax:
Practice Address - Street 1:4411 SUWANEE DAM RD STE 720
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8708
Practice Address - Country:US
Practice Address - Phone:678-993-8494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor