Provider Demographics
NPI:1689455701
Name:CARTER-SULLIVAN, KAYLEE NICOLE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:KAYLEE
Middle Name:NICOLE
Last Name:CARTER-SULLIVAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 LAKESHORE VLG E
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5608
Mailing Address - Country:US
Mailing Address - Phone:985-774-0335
Mailing Address - Fax:
Practice Address - Street 1:540 S MILITARY RD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-2616
Practice Address - Country:US
Practice Address - Phone:985-641-3033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17433104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker