Healthcare Provider Details

I. General information

NPI: 1770814790
Provider Name (Legal Business Name): TAMIKA MICHELLE SULLIVAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMIKA MICHELLE WILLIAMS

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 CALLE PORTAL STE C240
SIERRA VISTA AZ
85635-2986
US

IV. Provider business mailing address

4655A N. COMMERCE DRIVE
SIERRA VISTA AZ
85635
US

V. Phone/Fax

Practice location:
  • Phone: 520-515-8669
  • Fax: 520-515-8688
Mailing address:
  • Phone: 520-459-3012
  • Fax: 520-459-3207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC006080
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: