Healthcare Provider Details

I. General information

NPI: 1760793756
Provider Name (Legal Business Name): KARINDA DAWN SULLIVAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 HIGHWAY 62 W
SALEM AR
72576-8059
US

IV. Provider business mailing address

PO BOX 83
CORNING AR
72422-0083
US

V. Phone/Fax

Practice location:
  • Phone: 870-895-2735
  • Fax: 870-895-2709
Mailing address:
  • Phone: 870-857-3334
  • Fax: 870-857-9934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5878-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: