Doctor Name: | MICHAEL ROBERT SULLIVAN |
NPI Number: | 1003288796 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | C.D.P. |
License Number: | CP 60390649 |
Business Practice Address: | 14525 N Newport Hwy Mead, WA - 990219636 |
Business Phone Number: | 5093409643 |
Business Fax Number: | 5093689764 |
Mailing Address: | 14525 N Newport Hwy, MEAD |
State: | WA |
Postal Code: | 990219636 |
Phone Number: | 5093409643 |
Fax Number: | 5093689764 |
NPI Enumeration Date: | 10/21/2015 |
NPI Last Update Date: | 03/23/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | CP 60390649 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |