Provider Demographics
NPI:1235694456
Name:SULLIVAN, LEANN (MS)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:
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 1:9502 PARKER PLACE DR
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-2873
Mailing Address - Country:US
Mailing Address - Phone:757-617-3208
Mailing Address - Fax:
Practice Address - Street 1:9502 PARKER PLACE DR
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-2873
Practice Address - Country:US
Practice Address - Phone:757-617-3208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling