Provider Demographics
NPI:1861459653
Name:SULLIVAN, DANIEL J (LPC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 LINKHORNE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-3321
Mailing Address - Country:US
Mailing Address - Phone:434-384-1594
Mailing Address - Fax:
Practice Address - Street 1:2811 LINKHORNE DR
Practice Address - Street 2:SUITE B
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-3321
Practice Address - Country:US
Practice Address - Phone:434-384-1594
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003299101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA186387OtherANTHEM