Healthcare Provider Details

I. General information

NPI: 1235285487
Provider Name (Legal Business Name): SULLIVAN, NOLAN & ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2007
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 W LIBERTY RD
ANN ARBOR MI
48103-9056
US

IV. Provider business mailing address

3700 W LIBERTY RD
ANN ARBOR MI
48103-9056
US

V. Phone/Fax

Practice location:
  • Phone: 734-426-0032
  • Fax: 734-426-0034
Mailing address:
  • Phone: 734-426-0032
  • Fax: 734-426-0034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301006105
License Number StateMI

VIII. Authorized Official

Name: DR. KRISTINA RASK
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 734-426-0032