Provider Demographics
NPI:1508114745
Name:SULLIVAN, CAITLIN F (LCSWA)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:F
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 CROCKETT DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-6811
Mailing Address - Country:US
Mailing Address - Phone:252-353-4968
Mailing Address - Fax:
Practice Address - Street 1:2313 EXECUTIVE CIR STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3744
Practice Address - Country:US
Practice Address - Phone:252-353-4968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0075081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical