Provider Demographics
NPI:1275047359
Name:SULLIVAN, WILLIAM M JR (CAADC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:M
Last Name:SULLIVAN
Suffix:JR
Gender:M
Credentials:CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 CENTRAL ST STE 10
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03235-2040
Mailing Address - Country:US
Mailing Address - Phone:540-820-7246
Mailing Address - Fax:
Practice Address - Street 1:880 CENTRAL ST STE 10
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NH
Practice Address - Zip Code:03235-2040
Practice Address - Country:US
Practice Address - Phone:540-820-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1135101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)