Provider Demographics
NPI:1346740156
Name:SULLIVAN, ZENNIE L
Entity Type:Individual
Prefix:
First Name:ZENNIE
Middle Name:L
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-4624
Mailing Address - Country:US
Mailing Address - Phone:567-202-7813
Mailing Address - Fax:
Practice Address - Street 1:5565 AIRPORT HWY STE 100
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-7391
Practice Address - Country:US
Practice Address - Phone:419-720-5800
Practice Address - Fax:419-720-4444
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801021101YA0400X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)