Healthcare Provider Details

I. General information

NPI: 1073126090
Provider Name (Legal Business Name): COLLEEN CATHERINE LHOTSKY SULLIVAN M.A., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. COLLEEN CATHERINE LHOTSKY

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 11/17/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 1/2 WEST 5TH NORTH STREET
SUMMERVILLE SC
29483
US

IV. Provider business mailing address

PO BOX 1170
SUMMERVILLE SC
29484-1170
US

V. Phone/Fax

Practice location:
  • Phone: 843-779-7492
  • Fax:
Mailing address:
  • Phone: 843-779-7492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7587
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: