Provider Demographics
NPI:1184923427
Name:SULLIVAN, JULIA CECILE (MT-BC)
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:CECILE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 BARKER HILL RD
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-3015
Mailing Address - Country:US
Mailing Address - Phone:703-481-8565
Mailing Address - Fax:
Practice Address - Street 1:903 BARKER HILL RD
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-3015
Practice Address - Country:US
Practice Address - Phone:703-481-8565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09687102X00000X, 103TM1800X, 225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities