Provider Demographics
NPI:1942074505
Name:SULLIVAN, CARL LAWRENCE II (LPC)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:LAWRENCE
Last Name:SULLIVAN
Suffix:II
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5740 AMES BLVD
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-6627
Mailing Address - Country:US
Mailing Address - Phone:504-239-3772
Mailing Address - Fax:
Practice Address - Street 1:252 HECTOR AVE STE A
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-2548
Practice Address - Country:US
Practice Address - Phone:504-435-1444
Practice Address - Fax:504-372-2775
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9769101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional