Provider Demographics
NPI:1861829491
Name:SULLIVAN, STYLACIA DENISE
Entity Type:Individual
Prefix:MS
First Name:STYLACIA
Middle Name:DENISE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 ZIMALCREST DR APT 1606
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-6571
Mailing Address - Country:US
Mailing Address - Phone:864-329-5830
Mailing Address - Fax:
Practice Address - Street 1:716 ZIMALCREST DR APT 1606
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-6571
Practice Address - Country:US
Practice Address - Phone:864-329-5830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health