Provider Demographics
NPI:1639829955
Name:SULLIVAN, JESSICA JANE (LPCMH)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:JANE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 BRIDGEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-1617
Mailing Address - Country:US
Mailing Address - Phone:302-349-6051
Mailing Address - Fax:
Practice Address - Street 1:413 HIGH ST
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3923
Practice Address - Country:US
Practice Address - Phone:443-720-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0011180101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health