Healthcare Provider Details

I. General information

NPI: 1508351024
Provider Name (Legal Business Name): ATINA LORENE SULLIVAN NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ATINA L COVINGTON

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 DOBBIN RD STE D
COLUMBIA MD
21045-4770
US

IV. Provider business mailing address

3205 DORSTONE PL
UPPER MARLBORO MD
20774-8099
US

V. Phone/Fax

Practice location:
  • Phone: 410-730-2385
  • Fax:
Mailing address:
  • Phone: 301-404-8851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR250751
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: