Provider Demographics
NPI:1376985093
Name:SULLIVAN, SARAH CATHERINE (MED)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:CATHERINE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9529 HEATHER SPRING DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23238-4461
Mailing Address - Country:US
Mailing Address - Phone:540-295-3103
Mailing Address - Fax:
Practice Address - Street 1:9529 HEATHER SPRING DR
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23238-4461
Practice Address - Country:US
Practice Address - Phone:540-295-3103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000022103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst