Healthcare Provider Details

I. General information

NPI: 1235137894
Provider Name (Legal Business Name): MICHELLE LEE SULLIVAN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE LEE ADAMS

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 N PARHAM RD SUITE 3
RICHMOND VA
23229-3156
US

IV. Provider business mailing address

2305 N PARHAM RD SUITE 3
RICHMOND VA
23229-3156
US

V. Phone/Fax

Practice location:
  • Phone: 804-270-1124
  • Fax: 804-270-2090
Mailing address:
  • Phone: 804-270-1124
  • Fax: 804-270-2090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810004894
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: