Healthcare Provider Details

I. General information

NPI: 1225510753
Provider Name (Legal Business Name): HANNAH SULLIVAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 KRAFT AVE SE
GRAND RAPIDS MI
49512
US

IV. Provider business mailing address

1314 CALVIN AVE SE
GRAND RAPIDS MI
49506-3212
US

V. Phone/Fax

Practice location:
  • Phone: 586-943-3292
  • Fax:
Mailing address:
  • Phone: 586-943-3292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801085815
License Number StateMI

VIII. Authorized Official

Name: MS. HANNAH CHRISTINE SULLIVAN
Title or Position: OWNER/THERAPIST
Credential: LMSW, LMFT
Phone: 586-943-3292