Provider Demographics
NPI:1881924264
Name:SULLIVAN, DEBORAH ANNE (MS REHAB COUNSELING)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANNE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MS REHAB COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:204 SOUTH STREET UNION COUNTY COUNSELING SERVICES, INC.
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-0548
Mailing Address - Country:US
Mailing Address - Phone:618-833-8551
Mailing Address - Fax:
Practice Address - Street 1:204 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-0548
Practice Address - Country:US
Practice Address - Phone:618-833-8551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-007278101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional