Doctor Name: | SHANNON O'SULLIVAN |
NPI Number: | 1053783035 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | PC008395 |
Business Practice Address: | 4200 School Ln Drexel Hill, PA - 190265244 |
Business Phone Number: | 4849192632 |
Business Fax Number: | |
Mailing Address: | 4200 School Ln, DREXEL HILL |
State: | PA |
Postal Code: | 190265244 |
Phone Number: | 4849192632 |
Fax Number: | |
NPI Enumeration Date: | 10/29/2015 |
NPI Last Update Date: | 10/29/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | PC008395 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |