Healthcare Provider Details

I. General information

NPI: 1902219678
Provider Name (Legal Business Name): PEGGY A SULLIVAN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 20TH ST STE 500
WHEELING WV
26003-3747
US

IV. Provider business mailing address

32 20TH ST STE 500
WHEELING WV
26003-3747
US

V. Phone/Fax

Practice location:
  • Phone: 304-218-2023
  • Fax: 304-218-2026
Mailing address:
  • Phone: 304-218-2023
  • Fax: 304-218-2026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberDP00943830
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: