Healthcare Provider Details

I. General information

NPI: 1881507101
Provider Name (Legal Business Name): LISA MARIE SULLIVAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 BAY RIDGE AVE STE 190
ANNAPOLIS MD
21403-2834
US

IV. Provider business mailing address

5 GURTEEN CT UNIT 101
LUTHERVILLE TIMONIUM MD
21093-6529
US

V. Phone/Fax

Practice location:
  • Phone: 443-281-9430
  • Fax:
Mailing address:
  • Phone: 410-812-7740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number07937
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: