Provider Demographics
NPI:1851783286
Name:SULLIVAN, DANIELLE D (LMFTA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:D
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:HOLLY RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28445-0454
Mailing Address - Country:US
Mailing Address - Phone:910-319-8558
Mailing Address - Fax:833-799-3166
Practice Address - Street 1:13500 NC HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:SURF CITY
Practice Address - State:NC
Practice Address - Zip Code:28445-7934
Practice Address - Country:US
Practice Address - Phone:910-319-8558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-23
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2454106H00000X
NC12117A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist