Provider Demographics
NPI:1184411852
Name:SULLIVAN, KAYLEIGH JO (LICSW)
Entity type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:JO
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2248 N BEAUREGARD ST APT 12
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-2248
Mailing Address - Country:US
Mailing Address - Phone:831-747-4738
Mailing Address - Fax:
Practice Address - Street 1:2248 N BEAUREGARD ST APT 12
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-2248
Practice Address - Country:US
Practice Address - Phone:831-747-4738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC2000028581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical