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General NPI Number Information
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NPI Number | 1124804760
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Entity Type | Organization
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Legal Business Name | TINA J SULLIVAN COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 09/07/2023
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Last Update Date | 07/12/2024
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Provider Practice Location Address
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Address Line | 609 WASHINGTON AVE
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-4633
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Country | US
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Telephone | 662-251-3245
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Fax |
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Provider Business Mailing Address
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Address Line | 609 WASHINGTON AVE
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-4633
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Country | US
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Telephone | 662-251-3245
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TINA J SULLIVAN
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Credential | LPC
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Telephone | 662-251-3245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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