| Doctor Name: | MR. JAMES EDWARD SULLIVAN |
| NPI Number: | 1730343666 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MA. PSY |
| License Number: | |
| Business Practice Address: | 2076 Wallum Lake Rd Pascoag, RI - 02859 |
| Business Phone Number: | 4015681770 |
| Business Fax Number: | |
| Mailing Address: | 195 Admiral Kalbfus Rd Apt 12e, NEWPORT |
| State: | RI |
| Postal Code: | 028401372 |
| Phone Number: | 7189096197 |
| Fax Number: | |
| NPI Enumeration Date: | 07/10/2008 |
| NPI Last Update Date: | 07/10/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |