Provider Demographics
NPI:1184457301
Name:SULLIVAN, ANNE
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
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 1:1 CHASE CORPORATE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1000
Mailing Address - Country:US
Mailing Address - Phone:205-905-8497
Mailing Address - Fax:
Practice Address - Street 1:1 CHASE CORPORATE DR
Practice Address - Street 2:BUILDING 1, SUITE 110
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-1000
Practice Address - Country:US
Practice Address - Phone:205-905-8497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC05013101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health