Healthcare Provider Details

I. General information

NPI: 1780547000
Provider Name (Legal Business Name): JOHN SULLIVAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WHITNEY DR
MILFORD OH
45150-8402
US

IV. Provider business mailing address

25 WHITNEY DR STE 120
MILFORD OH
45150-8400
US

V. Phone/Fax

Practice location:
  • Phone: 513-654-2773
  • Fax:
Mailing address:
  • Phone: 513-654-2773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number192544
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: