Provider Demographics
NPI:1477710291
Name:SULLIVAN, ANDREA KAYE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:KAYE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:KAYE
Other - Last Name:GUFFEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:251 JOHNSTON ST SE STE 100
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-2515
Mailing Address - Country:US
Mailing Address - Phone:256-822-2375
Mailing Address - Fax:256-584-2330
Practice Address - Street 1:16 MOULTON ST E
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-2310
Practice Address - Country:US
Practice Address - Phone:256-822-2375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AL3066101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51549722OtherBCBS