Provider Demographics
NPI:1467638882
Name:SULLIVAN, DOLLY L (LICSW)
Entity type:Individual
Prefix:
First Name:DOLLY
Middle Name:L
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 1:937 CHEAT RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-5631
Mailing Address - Country:US
Mailing Address - Phone:304-288-3504
Mailing Address - Fax:304-777-4487
Practice Address - Street 1:937 CHEAT RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-5631
Practice Address - Country:US
Practice Address - Phone:304-288-3504
Practice Address - Fax:304-777-4487
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00943037104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker