Provider Demographics
NPI:1598892887
Name:SULLIVAN, ERICA JW (MA)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:JW
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 O ST STE 300
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2647
Mailing Address - Country:US
Mailing Address - Phone:402-882-2226
Mailing Address - Fax:888-959-0716
Practice Address - Street 1:8101 O ST STE 300
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2647
Practice Address - Country:US
Practice Address - Phone:402-882-2226
Practice Address - Fax:888-959-0716
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3375101YM0800X
NE1714101YP2500X
NE1043101YM0800X
NE793101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)