Provider Demographics
NPI:1326213489
Name:SULLIVAN, DIANA PATRICIA (LMHC CAP)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:PATRICIA
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LMHC CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1874 NW 97TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5666
Mailing Address - Country:US
Mailing Address - Phone:954-424-0821
Mailing Address - Fax:
Practice Address - Street 1:1874 NW 97TH AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5666
Practice Address - Country:US
Practice Address - Phone:954-253-2584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1087101YM0800X
FL3482101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health