Provider Demographics
NPI:1235173386
Name:SULLIVAN, ANNE K (EDD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:K
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1769 JAMESTOWN RD
Mailing Address - Street 2:SUITE R
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-2307
Mailing Address - Country:US
Mailing Address - Phone:757-564-7002
Mailing Address - Fax:757-229-4343
Practice Address - Street 1:1769 JAMESTOWN RD
Practice Address - Street 2:SUITE R
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2307
Practice Address - Country:US
Practice Address - Phone:757-564-7002
Practice Address - Fax:757-229-4343
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001763103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA242538OtherANTHEM
VA680001153Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST