Healthcare Provider Details

I. General information

NPI: 1235173386
Provider Name (Legal Business Name): ANNE K. SULLIVAN ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1769 JAMESTOWN RD SUITE R
WILLIAMSBURG VA
23185-2307
US

IV. Provider business mailing address

1769 JAMESTOWN RD SUITE R
WILLIAMSBURG VA
23185-2307
US

V. Phone/Fax

Practice location:
  • Phone: 757-564-7002
  • Fax: 757-229-4343
Mailing address:
  • Phone: 757-564-7002
  • Fax: 757-229-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810001763
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: